title: Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement, and torsion.
abstract: BACKGROUND
  The aim of this study was to characterize the ultrasonographic findings on nerves in neuralgic amyotrophy.
  
  
  METHODS
  Fourteen patients with neuralgic amyotrophy were examined using high-resolution ultrasound.
  
  
  RESULTS
  Four types of abnormalities were found: (1) focal or diffuse nerve/fascicle enlargement (57%); (2) incomplete nerve constriction (36%); (3) complete nerve constriction with torsion (50%; hourglass-like appearance); and (4) fascicular entwinement (28%). Torsions were confirmed intraoperatively and were seen on the radial nerve in 85% of patients. A significant correlation was found between no spontaneous recovery of nerve function and constriction/torsion/fascicular entwinement (P = 0.007).
  
  
  CONCLUSIONS
  Ultrasonographic nerve pathology in neuralgic amyotrophy varies in order of severity from nerve enlargement to constriction to nerve torsion, with treatment ranging from conservative to surgical. We postulate that the constriction caused by inflammation is the precursor of torsion and that development of nerve torsion is facilitated by the rotational movements of limbs.
authors.affiliation: Department of Neurology, MTA-SE NAP B Peripheral Nervous System Research Group, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Arányi
authors.affiliation: Department of Neurology, MTA-SE NAP B Peripheral Nervous System Research Group, Semmelweis University, Balassa u. 6, Budapest, 1083, Hungary.
authors.forename: Anita
authors.initials: A
authors.lastname: Csillik
authors.affiliation: Department of Traumatology, Szt. István and László Hospital, Budapest, Hungary.
authors.forename: Katalin
authors.initials: K
authors.lastname: Dévay
authors.affiliation: Department of Traumatology, Szt. István and László Hospital, Budapest, Hungary.
authors.forename: Maja
authors.initials: M
authors.lastname: Rosero
authors.affiliation: MRI Research Center, Semmelweis University, Budapest, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Barsi
authors.affiliation: Department of Neurology, Kreiskrankenhaus Freiberg, Freiberg, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Böhm
authors.affiliation: Department of Neurology, Städtisches Klinikum Dessau, Dessau, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schelle
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D020968:Brachial Plexus Neuritis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010525:Peripheral Nerves / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000209:etiology*; D014463:Ultrasonography / Q000379:methods
keywords: constriction; high-resolution ultrasound; hourglass-like appearance; nerve torsion; neuralgic amyotrophy