Thereby, location, extent and type of damage are determined. This allows displaying a complete and partial nerve transection, the distance and condition of the stumps (formation of a neuroma) or a compression of the nerve, for example by scars, ostheosynthetic material, callus formation, bone fragments, hematomas, or foreign bodies [2]. The most frequent alteration found in nerve trauma is axonal swelling. The nerve and VE-822 its fascicles show a hypoechoic thickening over several centimeters, in proximal limb lesions sometimes affecting the whole extremity. In severe traumas, axonal swelling persists over several months and diminishes

from proximal to distal with the forthcoming reinnervation (personal experience). Sonography allows differentiating major nerve trauma that requires surgical therapy, i.e. a complete and partial nerve neurotmesis. Since the degree of stump dehiscence determines the surgical procedure (neurorrhaphy in the case of a small defect, nerve transplant in the case of greater dehiscence), the distance of the nerve stumps should be measured. In longitudinal scans an amputation neuroma appears as a hypoechoic thickening or a bulbous mass where the nerve ends. In the case of a partial nerve transection, also intact parts of the nerve and its interfascicular epineurium can be seen (Fig. 4).

This type of lesion is very difficult to diagnose with clinical and electrophysiological methods especially in the early post-traumatic MG 132 period (within 3 months). Neuroma-in-continuity is represented by a fusiform hypoechoic thickened nerve with extincted nerve echotexture. Thus, NUS can facilitate the check therapeutic decisions and initiate early surgical intervention using the appropriate method (neurorrhaphy, nerve grafting or neurolysis). Postoperative complications such as dehiscence of the nerve sutures or abnormal scarring can be identified, too. The complete diagnosis of peripheral nerve damage includes not only the evaluation of nerve function

with clinical and electrophysiological methods, but also the assessment of nerve morphology with imaging methods. Sonography allows not only to set the diagnosis, but also to reveal the etiology of the condition. Hence, early and appropriate therapeutic measures can be derived. Sonography can be used as the screening imaging tool for all disease categories of the peripheral nervous system. “
“Since the first reports on sonographic evaluation of peripheral nerves [1] and [2], high-resolution ultrasound has evolved rapidly over the past two decades. The ability of ultrasonography to visualize even small structures like peripheral nerves makes ultrasonography complementary to electrodiagnostic studies. In addition to the information on nerve function, which is typically provided by nerve conduction studies (NCS) and electromyography (EMG), neuromuscular ultrasound permits direct assessment of pathologic changes in nerve structure and/or in the adjacent tissue, as well.