Introduction to Neuromuscular Ultrasound

Authors: K. Mezian 1;  P. Steyerová 2;  J. Vacek 3;  L. Navrátil 1
Authors‘ workplace: Katedra zdravotnických oborů a ochrany obyvatelstva, Fakulta biomedicínského inženýrství ČVUT v Praze 1;  Radiodiagnostická klinika 1. LF UK a VFN v Praze 2;  Klinika rehabilitačního lékařství 3. LF UK a FN Královské Vinohrady, Praha 3
Published in: Cesk Slov Neurol N 2016; 79/112(6): 656-661
Category: Review Article


Neuromuscular and musculoskeletal medicine is witnessing rapid development of high-resolution ultrasound, the advantages of which include absence of radiation exposure, no absolute contraindications, cost-effectiveness, dynamic imaging and repeatability. The present paper reviews the use of ultrasound in evaluating localized muscle and peripheral nerve lesions. Ultrasound can also be used to detect muscle fasciculations and fibrillations. It also enables detection of morphological changes accompanying chronic myopathies. Ultrasound is a valuable tool to guide various interventional procedures (fluid aspiration, botulinum toxin injection, joint injections, nerve blocks etc).

Key words:
median nerve – peripheral nerve – musculoskeletal – ultrasound – utrasonography – entrapment syndrome – carpal tunnel syndrome – interventional methods – ultrasound guidance – amputation neuroma

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


1. Sharpe RE, Nazarian LN, Parker L, et al. Dramatical­ly in­creased musculoskeletal ultrasound utilization from 2000 to 2009, especial­ly by podiatrists in private of­fices. J Am Coll Radiol JACR 2012;9(2):141– 6. doi: 10.1016/ j.jacr.2011.09.008.

2. Stoll G, Wilder-Smith E, Bendszus M. Imag­ing of the peripheral nervous system. Handb Clin Neurol 2013;115: 137– 53. doi: 10.1016/ B978-0-444-52902-2.00008-4.

3. Hrazdira L. Možnosti 3D ultrazvukového vyšetřování a prostorových rekonstrukcí pohybového aparátu. Brno: Paido 2004.

4. Ehler E. Použití botulotoxinu v neurologii. Cesk Slov Neurol N 2013;76/ 109(1):7– 21.

5. Wilson DJ, Scul­ly WF, Rawlings JM. Evolv­ing role of ultrasound in therapeutic injections of the upper extremity. Orthopedics 2015;38(11):e1017– 24. doi: 10.3928/ 01477447-20151020-11.

6. Sites BD, Spence BC, Gal­lagher JD, et al. Characteriz­ing novice behavior as­sociated with learn­ing ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med 2007;32(2):107– 15.

7. Çağlayan G, Özçakar L, Kaymak SU, et al. Ef­fects of Sono-feedback dur­ing aspiration of Baker’s cysts: a control­led clinical trial. J Rehabil Med 2016;48(4):386– 9. doi: 10.2340/ 16501977-2049.

8. Zaidman C. Ultrasound of muscular dystrophies, myopathies, and muscle pathology. In: Walker FO, Cartwright MS (eds). Neuromuscular Ultrasound. 1st ed. Philadelphia: Elsevier 2011:131– 49.

9. Pil­len S, Arts IMP, Zwarts MJ. Muscle ultrasound in neuromuscular disorders. Muscle Nerve 2008;37(6):679– 93. doi: 10.1002/ mus.21015.

10. Pil­len S, Ver­rips A, van Alfen N, et al. Quantitative skeletal muscle ultrasound: dia­gnostic value in child­hood neuromuscular disease. Neuromuscul Disord 2007;17(7):509– 16.

11. Walker FO, Donofrio PD, Harpold GJ, et al. Sonographic imag­ing of muscle contraction and fasciculations: a cor­relation with electromyography. Muscle Nerve 1990;13(1):33– 9.

12. Pil­len S, Nienhuis M, van Dijk JP, et al. Muscles alive: ultrasound detects fibril­lations. Clin Neurophysiol 2009;120(5):932– 6. doi: 10.1016/ j.clinph.2009.01.016.

13. van Alfen N, Nienhuis M, Zwarts MJ, et al. Detection of fibril­lations us­ing muscle ultrasound: dia­gnostic accuracy and identification of pitfal­ls. Muscle Nerve 2011;43(2):178– 82. doi: 10.1002/ mus.21863.

14. Won SJ, Kim BJ, Park KS, et al. Reference values for nerve ultrasonography in the upper extremity. Muscle Nerve 2013;47(6):864– 71. doi: 10.1002/ mus.23691.

15. Simonetti S, Bianchi S, Martinoli C. Neurophysiological and ultrasound findings in sural nerve lesions fol­low­ing stripp­ing of the small saphenous vein. Muscle Nerve 1999;22(12):1724– 6.

16. Demondion X, Herbinet P, Boutry N, et al. Sonographic mapp­ing of the normal brachial plexus. AJNR Am J Neuroradiol 2003;24(7):1303– 9.

17. Özçakar L, Kara M, Yalçın B, et al. Bypas­s­ing the chal­lenges of lower-limb electromyography by us­ing ultrasonography: AnatoMUS-II. J Rehabil Med 2013;45(6):604– 5. doi: 10.2340/ 16501977-1162.

18. Kurča E. Syndrom karpálného tunela. Cesk Slov Neurol N 2009;72/ 105(6):499– 510.

19. Vis­ser LH. High-resolution sonography of the com­mon peroneal nerve: detection of intraneural ganglia. Neurology 2006;67(8):1473– 5.

20. Kurča E, Nosal V, Grofik M, et al. Single parameter wrist ultrasonography as a first-line screen­ing examination in suspected carpal tun­nel syndrome patients. Bratisl Lek Listy 2008;109(4):177– 9.

21. Qrimli M, Ebadi H, Breiner A, et al. Reference values for ultrasonograpy of peripheral nerves. Muscle Nerve 2016;53(4):538– 44. doi: 10.1002/ mus.24888.

22. Sugimoto T, Ochi K, Hosomi N, et al. Ultrasonographic nerve enlargement of the median and ulnar nerves and the cervical nerve roots in patients with demyelinat­ing Charcot-Marie-Tooth disease: distinction from patients with chronic inflam­matory demyelinat­ing polyneuropathy. J Neurol 2013;260(10):2580– 7. doi: 10.1007/ s00415-013-7021-0.

23. Watanabe T, Ito H, Sekine A, et al. Sonographic evaluation of the peripheral nerve in diabetic patients: the relationship between nerve conduction studies, echo intensity, and cros­s-sectional area. J Ultrasound Med 2010;29(5):697– 708.

24. Ghasemi-Esfe AR, Morteza A, Khalilzadeh O, et al. Color Doppler ultrasound for evaluation of vasomotor activity in patients with carpal tun­nel syndrome. Skeletal Radiol 2012;41(3):281– 6. doi: 10.1007/ s00256-011-1149-8.

25. Hough AD, Moore AP, Jones MP. Reduced longitudinal excursion of the median nerve in carpal tun­nel syndrome. Arch Phys Med Rehabil 2007;88(5):569– 76.

26. Filippou G, Mondel­li M, Greco G, et al. Ulnar neuropathy at the elbow: how frequent is the idiopathic form? An ultrasonographic study in a cohort of patients. Clin Exp Rheumatol 2010;28(1):63– 7.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 6

2016 Issue 6

Most read in this issue
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account