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High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy Cover

High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy

Journal of Ultrasonography
Volume 17 (2017): Issue 71 (December 2017)
By: Kunwarpal Singh,  Kamlesh Gupta and  Sukhdeep Kaur  
Open Access
|Dec 2017

Figures & Tables

Fig. 1

Patient position for focusing the tibial nerve (A). Arrow in B demonstrates the marking of the upper end of the medial malleolus. Arrow in C marks the position of the probe, 3 cm proximal to the upper end of the medial malleolus. M – the medial malleolus
Patient position for focusing the tibial nerve (A). Arrow in B demonstrates the marking of the upper end of the medial malleolus. Arrow in C marks the position of the probe, 3 cm proximal to the upper end of the medial malleolus. M – the medial malleolus

Fig. 2

A transverse view of the tibial nerve, showing a honeycomb pattern (straight arrow in A) due to hypoechoic areas (nerve fascicle groups) distributed over a hyperechoic background (perineurium). The echopoor areas are posterior tibial vessels (curved arrow in A). In the longitudinal view, the nerve appears as the long, slim structure with alternate hypoechoic and hyperechoic stripes (Straight arrow in B).
A transverse view of the tibial nerve, showing a honeycomb pattern (straight arrow in A) due to hypoechoic areas (nerve fascicle groups) distributed over a hyperechoic background (perineurium). The echopoor areas are posterior tibial vessels (curved arrow in A). In the longitudinal view, the nerve appears as the long, slim structure with alternate hypoechoic and hyperechoic stripes (Straight arrow in B).

Fig. 3

High resolution US of a 44-year old male diabetic patient with no clinical signs of peripheral neuropathy (TCNS - 4 and DN score -0) shows CSA of 18 mm2 (straight arrow in A) and MTNF of 0.4 mm (curved arrow in B). US of a 36-year old healthy male shows CSA of 11 mm2 (elbow arrow in C) and MTNF of 0.2 mm (elbow arrow in D)
High resolution US of a 44-year old male diabetic patient with no clinical signs of peripheral neuropathy (TCNS - 4 and DN score -0) shows CSA of 18 mm2 (straight arrow in A) and MTNF of 0.4 mm (curved arrow in B). US of a 36-year old healthy male shows CSA of 11 mm2 (elbow arrow in C) and MTNF of 0.2 mm (elbow arrow in D)

Fig. 4

High resolution US of a 70-year old male diabetic patient with severe peripheral neuropathy (TCNS-15 and DN score -3) shows a swollen tibial nerve (straight arrow in A) with CSA of 29 mm2 (elbow arrow in B) and MTNF of 0.6 mm (curved arrow in C)
High resolution US of a 70-year old male diabetic patient with severe peripheral neuropathy (TCNS-15 and DN score -3) shows a swollen tibial nerve (straight arrow in A) with CSA of 29 mm2 (elbow arrow in B) and MTNF of 0.6 mm (curved arrow in C)

Clinical and biochemical characteristics of patients, CSA, MTNF and TCNS results_ Group I – diabetic patients with peripheral neuropathy, Group II – diabetic patients without peripheral neuropathy, Group III – non-diabetic subjects

Clinical and biochemical characteristicsGroup I(N = 75)Group II(N = 58)Group III(N = 75)
Age in years (Mean +/− SD)Range59.30 +/− 12.11(40–89)46.98 +/− 6.82(33–60)39.54 +/− 10.12(23–72)
Duration of diabetes in years (Mean +/− SD)Range13.98 +/− 7.06(5–38)7.53 +/− 4.26(1–19)−
Male : Female46 : 2932 : 2644 : 31
Weight in kg (mean +/− SD)Range78.52 +/− 9.60(53–96)63.24 +/− 9.89(40–80)63.34 +/− 10.33(40–85)
Systolic blood pressure in mmHg (mean +/− SD)Range138.48 +/− 10.37(110–160)121.48 +/− 9.58(100–146)120.77 +/− 9.34(100–140)
Diastolic blood pressure in mmHg (mean +/− SD)Range83.46 +/− 6.54(68–94)76.68 +/− 6.19(64–90)76.26 +/− 6.09(60–86)
HbA1c levels in % (mean +/− SD)Range7.84 +/− 1.20(6.10–12.50)5.92 +/− 0.69(5.0–7.30)5.23 +/− 0.23(5.0–5.92)
CSA of the tibial nerve in mm2 (mean +/− SD)Range22.63 +/− 2.66(18.5–29)14.40 +/− 1.72(12–18.5)12.42 +/− 1.10(10–14)
MTNF of the tibial nerve in mm (mean +/− SD)Range0.47 +/− 0.09(0.30–0.70)0.23 +/− 0.06(0.10–0.40)0.20 +/− 0.05(0.10–0.30)
TCNS (mean +/− SD)Range10.14 +/− 3.45(6.0–18.5)1.67 +/− 1.61(0–5)−
DOI: https://doi.org/10.15557/jou.2017.0036 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404
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Language: English
Page range: 246 - 252
Submitted on: Sep 5, 2017
Accepted on: Oct 18, 2017
Published on: Dec 29, 2017
Published by: MEDICAL COMMUNICATIONS Sp. z o.o.
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
diabetes mellitus,
tibial nerve,
ultrasonography
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2017 Kunwarpal Singh, Kamlesh Gupta, Sukhdeep Kaur, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial 3.0 License.

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