Imaging of Entrapment and Compressive Neuropathies

ABSTRACT

Although the subject of entrapment and compressive neuropathies is huge, with dedicated textbooks on the subject, this article attempts to provide an up-to-date overview of the role of imaging in the diagnosis of nerve entrapment and compression syndromes. Entrapment and compressive neuropathies are a group of distinct syndromes secondary to physical constriction or irritation affecting peripheral nerves at specific anatomical sites in the body. Most nerve entrapment and compressive syndromes derive from an injury to the neurovascular components in a narrow anatomical passage. Because of their etiological diversity, which includes pressure, angulation, stretch, and friction, the pathophysiology of individual nerve entrapment syndromes differs widely. Neuropathy can result in considerable morbidity. Although the mainstay of achieving diagnosis is with clinical acumen and electrophysiological investigations, the increasing use of modern high-resolution imaging studies is of particular value in confirming physical findings and enabling determination of the extent of injury. Knowledge and familiarity of pertinent anatomy and appropriate choice of imaging modality is important for the radiologist to allow accurate interpretation of site and etiology of nerve entrapment and compression as well as ascertaining possible alternative diagnoses.

KEYWORDS

Peripheral nerves - entrapment neuropathy - nerve compression - MRI - ultrasound

REFERENCES

• 1 Pećina M M, Krmpotić-Nemanić J, Markiewtz A D. Tunnel Syndromes: Peripheral Nerve Compression Syndromes. 3rd ed. Boca Raton, FL; CRC Press 2001
• 2 Durrant D H, True J M. Myelopathy, Radiculopathy, and Peripheral Entrapment Syndromes. 3rd ed. Boca Raton, FL; CRC Press 2002
• 3 Ellis J RC, McNally E G, Scott P M. Ultrasound of peripheral nerves.  Imaging. 2002;  14(3) 217-222
• 4 Hochman M G, Zilberfarb J L. Nerves in a pinch: imaging of nerve compression syndromes.  Radiol Clin North Am. 2004;  42 221-245
• 5 Lundborg G. Intraneural microcirculation.  Orthop Clin North Am. 1988;  19 1-12
• 6 Mallouhi A, Pültzl P, Trieb T, Piza H, Bodner G. Predictors of carpal tunnel syndrome: accuracy of gray-scale and color Doppler sonography.  AJR Am J Roentgenol. 2006;  186 1240-1245
• 7 Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi L E. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs.  Radiographics. 2000;  20 S199-S217
• 8 Keberle M, Jenett M, Kenn W et al.. Technical advances in ultrasound and MR imaging of carpal tunnel syndrome.  Eur Radiol. 2000;  10 1043-1050
• 9 Martinoli C, Bianchi S, Derchi L E. Ultrasonography of peripheral nerves.  Semin Ultrasound CT MR. 2000;  21(3) 205-213
• 10 Kransdorf M J, Berquist T H. Musculoskeletal neoplasms. In: Berquist TH MRI of the Musculoskeletal System. 4th ed. Philadelphia; Lippincott Williams & Wilkins 2001: 842-955
• 11 Allieu Y, Mackinnon S E. Nerve Compression Syndromes of the Upper Limb. London; Martin Dunitz 2002
• 12 Cummins C A, Messer T M, Nuber G W. Suprascapular nerve entrapment.  J Bone Joint Surg Am. 2000;  82(3) 415-424
• 13 Bencardino J T, Rosenberg Z S. Entrapment neuropathies of the shoulder and elbow in the athlete.  Clin Sports Med. 2006;  25 465-487
• 14 Fritz R C, Helms C A, Steinbach L S, Genant H K. Suprascapular nerve entrapment: evaluation with MR imaging.  Radiology. 1992;  182(2) 437-444
• 15 Demirhan M, Imhoff A B, Debski R E, Patel P R, Fu F H, Woo S L. The spinoglenoid ligament and its relationship to the suprascapular nerve.  J Shoulder Elbow Surg. 1998;  7 238-243
• 16 Gaskin C M, Helms C A. Parsonage-Turner syndrome: MR imaging findings and clinical information of 27 patients.  Radiology. 2006;  240 501-507
• 17 Chautems R C, Glauser T, Waeber-Fey M C, Rostan O, Georges-Edouard B. Quadrilateral space syndrome: case report and review of the literature.  Ann Vasc Surg. 2000;  14 673-676
• 18 Linker C S, Helms C A, Fritz R C. Quadrilateral space syndrome: findings at MR imaging.  Radiology. 1993;  188(3) 675-676
• 19 Koltzenburg M, Bendszus M. Imaging of peripheral nerve lesions.  Curr Opin Neurol. 2004;  17 621-626
• 20 Andreisek G, Crook D W, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features.  Radiographics. 2006;  26 1267-1287
• 21 Bordalo-Rodrigues M, Rosenberg Z S. MR imaging of entrapment neuropathies at the elbow.  Magn Reson Imaging Clin N Am. 2004;  12 247-263
• 22 Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves.  Skeletal Radiol. 2005;  34 1-18
• 23 Bordalo-Rodrigues M, Amin P, Rosenberg Z S. MR imaging of common entrapment neuropathies at the wrist.  Magn Reson Imaging Clin N Am. 2004;  12 265-279
• 24 Martinoli C, Bianchi S, Pugliese F et al.. Sonography of entrapment neuropathies in the upper limb (wrist excluded).  J Clin Ultrasound. 2004;  32(9) 438-450
• 25 Ferdinand B D, Rosenberg Z S, Schweitzer M E et al.. MR imaging features of radial tunnel syndrome: initial experience.  Radiology. 2006;  240 161-168
• 26 Bodner G, Harpf C, Meirer R, Gardetto A, Kovacs P, Gruber H. Ultrasonographic appearance of supinator syndrome.  J Ultrasound Med. 2002;  21 1289-1293
• 27 Filler A G, Haynes J, Jordan S E. Sciatica of non-disc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment.  J Neurosurg Spine. 2005;  2(2) 99-115
• 28 Lee E Y, Margherita A J, Gierada D S, Narra V R. MRI of piriformis syndrome.  AJR Am J Roentgenol. 2004;  183 63-64
• 29 Kosukegawa I, Yoshimoto M, Isoqai S, Nonaka S, Yamashita T. Piriformis syndrome resulting from a rare anatomic variation.  Spine. 2006;  31(18) E664-E666
• 30 Apter S, Hertz M, Rubinstein Z J, Moraq B. Femoral neuropathy: The role of computed tomography in diagnosis and management in 27 patients.  Clin Radiol. 1989;  40 30-34
• 31 Bradshaw C, McCrory P. Obturator nerve entrapment.  Clin J Sport Med. 1997;  7(3) 217-219
• 32 House C V, Ali K E, Bradshaw C, Connell D A. CT-guided obturator nerve block via the posterior approach.  Skeletal Radiol. 2006;  35 227-232
• 33 Reade B M, Longo D C, Keller M C. Tarsal tunnel syndrome.  Clin Podiatr Med Surg. 2001;  18 395-408
• 34 Zanetti M, Strehle J K, Kundert H P, Zollinger H, Hodler J. Morton neuroma: effect of MR imaging findings on diagnostic thinking and therapeutic decisions.  Radiology. 1999;  213(2) 583-588
• 35 Hughes R J, Ali K, Jones H, Kendall S, Connell D A. Treatment of Morton's neuroma with alcohol injection under sonographic guidance.  AJR Am J Roentgenol. 2007;  188 1535-1539
• 36 Dawson D M, Hallett M, Wilbourn A J. Miscellaneous uncommon syndromes of the lower extremity. In: Dawson DM, Hallett M,Wilbourn AJ Entrapment Neuropathies. 3rd ed. Philadelphia; Lippincott-Raven 1999: 369-379
• 37 Fabre T, Montero C, Gaujard E, Gervais-Dellion F, Durandeau A. Chronic calf pain in athletes due to sural nerve entrapment. A report of 18 cases.  Am J Sports Med. 2000;  28 679-682