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

Tanu Ranjan
Tanu Ranjan
, 
Shruti Chandak
Shruti Chandak
, 
Ankur Malhotra
Ankur Malhotra
, 
Arjit Aggarwal
Arjit Aggarwal
, 
Jigar Haria
Jigar Haria
 y 
Deepak Singla
Deepak Singla
   | 01 oct 2022
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Article Category: research-paper
Publicado en línea: 01 oct 2022
Páginas: e209 - e215
Recibido: 19 mar 2022
Aceptado: 14 jun 2022
DOI: https://doi.org/10.15557/jou.2022.0035
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© 2022 Tanu Ranjan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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)

Variables Minimum Maximum Mean Std. deviation
MN 5 cm 5 15 9.59 2.440
TN 1 cm 5 18 10.97 3.355
TN 3 cm 6 18 11.16 3.313
TN 5 cm 5 19 11.06 3.296

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

Parameters HBA1C RBS (mg/dl) DOI (years)
MN 5 cm Pearson’s correlation 0.621* 0.491* 0.652*
Sig. (2-tailed) 0.000 0.000 0.000
TN 1 cm Pearson’s correlation 0.714* 0.512* 0.704*
Sig. (2-tailed) 0.000 0.000 0.000
TN 3 cm Pearson’s correlation 0.701* 0.507* 0.712*
Sig. (2-tailed) 0.000 0.000 0.000
TN 5 cm Pearson’s correlation 0.700* 0.502* 0.705*
Sig. (2-tailed) 0.000 0.000 0.000

Nerve parameters according to monofilament examination results

Monofilament examination MN 5 cm TN 1 cm TN 3 cm TN 5 cm
Negative Mean 10.90 12.80 13.02 12.90
SD 1.892 2.503 2.370 2.362
Positive Mean 7.30 7.78 7.91 7.87
SD 1.363 1.976 1.905 1.984
t test 63.82 67.89 77.91 74.10
p-value <0.01* <0.01* <0.01* <0.01*

HbA1c among the study subjects

HbA1c (in %) Number of patients % of patients
≤6.5 3 4.76
>6.5–9 48 76.19
>9 12 19.05
Total 63 100
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Medicine, Basic Medical Science, other
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