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Role of high-resolution ultrasonography in the evaluation of the tibial and median nerves in diabetic peripheral neuropathy Cover

Role of high-resolution ultrasonography in the evaluation of the tibial and median nerves in diabetic peripheral neuropathy

Journal of Ultrasonography
Volume 22 (2022): Issue 91 (October 2022)
By: Tanu Ranjan,  Shruti Chandak,  Ankur Malhotra,  Arjit Aggarwal,  Jigar Haria and  Deepak Singla  
Open Access
|Oct 2022

Figures & Tables

Fig. 1.

Transverse grey-scale ultrasound showing: A. Thickening of median nerve in a 65-year-old male patient diagnosed with T2DM 10 years previously. The patient had pain in both lower limbs. His HbA1c was 9% and his random blood sugar value was 400 mg/dl. It shows mean cross-sectional area of 15 mm2. B. Thickening of tibial nerve at 1 cm proximal to medial malleolus (in the same patient). C. Thickening of tibial nerve (in the same patient) at 3 cm proximal to medial malleolus. D. Thickening of tibial nerve (in the same patient) at 5 cm proximal to medial malleolus
Transverse grey-scale ultrasound showing: A. Thickening of median nerve in a 65-year-old male patient diagnosed with T2DM 10 years previously. The patient had pain in both lower limbs. His HbA1c was 9% and his random blood sugar value was 400 mg/dl. It shows mean cross-sectional area of 15 mm2. B. Thickening of tibial nerve at 1 cm proximal to medial malleolus (in the same patient). C. Thickening of tibial nerve (in the same patient) at 3 cm proximal to medial malleolus. D. Thickening of tibial nerve (in the same patient) at 5 cm proximal to medial malleolus

Fig. 2.

Transverse grey-scale ultrasound showing: A. Median nerve in a 45-year-old female patient diagnosed with T2DM 3 years previously. The patient did not have any neuropathic symptoms. Her HbA1c was 7.9% and her random blood sugar value was 250 mg/dl. It showed mean cross-sectional area of 8 mm2, meaning median nerve did not show any thickening. On monofilament examination, she was given a total score of 6 and her tactile sensations were intact. B. Thickening of tibial nerve (in the same patient) at 1 cm proximal to medial malleolus. C. Thickening of tibial nerve (in the same patient) at 3 cm proximal to medial malleolus. D. Thickening of tibial nerve (in the same patient) at 5 cm proximal to medial malleolus
Transverse grey-scale ultrasound showing: A. Median nerve in a 45-year-old female patient diagnosed with T2DM 3 years previously. The patient did not have any neuropathic symptoms. Her HbA1c was 7.9% and her random blood sugar value was 250 mg/dl. It showed mean cross-sectional area of 8 mm2, meaning median nerve did not show any thickening. On monofilament examination, she was given a total score of 6 and her tactile sensations were intact. B. Thickening of tibial nerve (in the same patient) at 1 cm proximal to medial malleolus. C. Thickening of tibial nerve (in the same patient) at 3 cm proximal to medial malleolus. D. Thickening of tibial nerve (in the same patient) at 5 cm proximal to medial malleolus

Mean description of MN 5 cm, TN 1 cm, TN 3 cm and TN 5 cm (CSA of the nerves in mm2 at various levels)

VariablesMinimumMaximumMeanStd. deviation
MN 5 cm5159.592.440
TN 1 cm51810.973.355
TN 3 cm61811.163.313
TN 5 cm51911.063.296

Correlation between the nerve CSA and HbA1c, RBS and duration of illness (DOI)

Parameters HBA1CRBS (mg/dl)DOI (years)
MN 5 cmPearson’s correlation0.621*0.491*0.652*
Sig. (2-tailed)0.0000.0000.000
TN 1 cmPearson’s correlation0.714*0.512*0.704*
Sig. (2-tailed)0.0000.0000.000
TN 3 cmPearson’s correlation0.701*0.507*0.712*
Sig. (2-tailed)0.0000.0000.000
TN 5 cmPearson’s correlation0.700*0.502*0.705*
Sig. (2-tailed)0.0000.0000.000

Nerve parameters according to monofilament examination results

Monofilament examinationMN 5 cmTN 1 cmTN 3 cmTN 5 cm
NegativeMean10.9012.8013.0212.90
SD1.8922.5032.3702.362
PositiveMean7.307.787.917.87
SD1.3631.9761.9051.984
t test63.8267.8977.9174.10
p-value<0.01*<0.01*<0.01*<0.01*

HbA1c among the study subjects

HbA1c (in %)Number of patients% of patients
≤6.534.76
>6.5–94876.19
>91219.05
Total63100
DOI: https://doi.org/10.15557/jou.2022.0035 | Journal eISSN: 2451-070X | Journal ISSN: 2084-8404
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Language: English
Page range: e209 - e215
Submitted on: Mar 19, 2022
Accepted on: Jun 14, 2022
Published on: Oct 1, 2022
Published by: MEDICAL COMMUNICATIONS Sp. z o.o.
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
diabetes,
peripheral neuropathy,
ultrasonography
Related subjects:
Medicine,
Basic medical science,
Basic medical science, other

© 2022 Tanu Ranjan, Shruti Chandak, Ankur Malhotra, Arjit Aggarwal, Jigar Haria, Deepak Singla, published by MEDICAL COMMUNICATIONS Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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