Focused high-resolution sonography of the suprascapular nerve: A simple surrogate marker for neuralgic amyotrophy?. Issue 8 (August 2017)

• Record Type: Journal Article
• Authors: Gruber, Leonhard; Loizides, Alexander; Löscher, Wolfgang; Glodny, Bernhard; Gruber, Hannes
• Is Part Of: Clinical neurophysiology. Volume 128:Issue 8(2017:Aug.)
• Page Start: 1438
• Page End: 1444
• Publication Date: 2017-08
• Subjects: HRUS high-resolution ultrasound -- BP brachial plexus -- NA neuralgic amyotrophy -- EDx electrophysiological testing -- SSN suprascapular nerve -- CSA cross-section area -- PPV/NPV positive/negative predictive value -- LR likelihood ratio -- OR odds ratio -- AUC area under the curve -- ROC receiver-operator characteristics -- T2w T2-weighted -- GBS Guillain-Barré syndrome; Neuralgic amyotrophy -- Parsonage-Turner syndrome -- Suprascapular nerve -- High-resolution ultrasonography -- Diagnostics; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2017.04.030
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Sonography of the suprascapular nerve can serve as a surrogate marker for neuralgic amyotrophy. Patients with neuralgic amyotrophy showed swelling of the suprascapular nerve on the affected side. This examination algorithm is simple and can substantiate the suspicion of neuralgic amyotrophy. Abstract: Objectives: To define the diagnostic value of high-resolution ultrasound (HRUS) of the suprascapular nerve (SSN) in the diagnosis of neuralgic amyotrophy (NA). Methods: The cross-section areas (CSA) of the SSN at the C5 root (CSA1) and the omohyoid muscle in the midclavicular line (CSA2) were assessed bilaterally in 15 healthy volunteers and 14 patients with clinically and electrophysiologically verified NA. Receiver-operator-characteristics (ROC) curves were generated and cut-off values, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), likelihood (LR) and odds ratios (OR) were calculated. Results: Patients with NA had significantly higher CSA2-values than controls (6.36 ± 2.75 vs. 2.79 ± 0.83 mm 2, p < 0.0001) and significantly higher ratios of SSN CSA2-values of the affected vs. contralateral side (224.6 ± 78.5% vs. 127.7 ± 51.1%, p < 0.0001). The ratios of SSN CSA2-values vs. CSA1-values (146.7 ± 74.5% vs. 99.9 ± 28.3%, p = 0.008) and CSA1-values were also significantly higher (4.70 ± 2.00 vs. 2.90 ± 0.90 mm 2, p = 0.0028) than in controls. Beyond a CSA2 cut-off value of 4.2 mm 2, the ROC-AUC was 0.939 [0.861–1.00] when compared against healthy volunteers and 0.971 [0.901–1.00] when compared to patients with degenerative shoulder pain. Sensitivity was 85.7% [57.2–98.2%], specificity 96.7% [82.8–99.9%], PPV 92.3% [64.0–99.8%], NPV 93.5% [78.6–99.2%], OR 174.0 [14.4–2106.0] and LR 25.7 (95% confidence intervals in brackets). Conclusion: SSN swelling in the lateral cervical region could be a supportive finding to identify NA patients. Significance: This method allows for the rapid sonographic identification of NA.