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High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy

Kunwarpal Singh
Kunwarpal Singh
, 
Kamlesh Gupta
Kamlesh Gupta
 and 
Sukhdeep Kaur
Sukhdeep Kaur
   | Dec 29, 2017
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Article Category: research-article
Published Online: Dec 29, 2017
Page range: 246 - 252
Received: Sep 05, 2017
Accepted: Oct 18, 2017
DOI: https://doi.org/10.15557/jou.2017.0036
Keywords
© 2017 Kunwarpal Singh et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial 3.0 Public License.

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)−
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