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      Sonographic Pearls for Imaging the Brachial Plexus and Its Pathologies

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          Abstract

          The brachial plexus (BP) is a complicated neural network, which may be affected by trauma, irradiation, neoplasm, infection, and autoimmune inflammatory diseases. Magnetic Resonance Imaging is the preferred diagnostic modality; however, it has the limitations of high cost and lack of portability. High-resolution ultrasound has recently emerged as an unparalleled diagnostic tool for diagnosing postganglionic lesions of the BP. Existing literature describes the technical skills needed for prompt ultrasound imaging and guided injections for the BP. However, it remains particularly challenging for beginners to navigate easily while scanning its different parts. To address this, we share several “clinical pearls” for the sonographic examination of the BP as well as its common pathologies.

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          Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment

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            Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications

            Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or collateral damage in traumatic insults. Scanning of the cutaneous nerves is challenging due to fewer anatomic landmarks for referencing. Therefore, the aim of the present article is to summarize the anatomy of the limb cutaneous nerves, to elaborate the scanning techniques, and also to discuss the clinical implications of pertinent entrapment syndromes of the medial brachial cutaneous nerve, intercostobrachial cutaneous nerve, medial antebrachial cutaneous nerve, lateral antebrachial cutaneous nerve, posterior antebrachial cutaneous nerve, superficial branch of the radial nerve, dorsal cutaneous branch of the ulnar nerve, palmar cutaneous branch of the median nerve, anterior femoral cutaneous nerve, posterior femoral cutaneous nerve, lateral femoral cutaneous nerve, sural nerve, and saphenous nerve.
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              Diagnosing Thoracic Outlet Syndrome: Current Approaches and Future Directions

              The diagnosis of thoracic outlet syndrome (TOS) has long been a controversial and challenging one. Despite common presentations with pain in the neck and upper extremity, there are a host of presenting patterns that can vary within and between the subdivisions of neurogenic, venous, and arterial TOS. Furthermore, there is a plethora of differential diagnoses, from peripheral compressive neuropathies, to intrinsic shoulder pathologies, to pathologies at the cervical spine. Depending on the subdivision of TOS suspected, diagnostic investigations are currently of varying importance, necessitating high dependence on good history taking and clinical examination. Investigations may add weight to a diagnosis suspected on clinical grounds and suggest an optimal management strategy, but in this changing field new developments may alter the role that diagnostic investigations play. In this article, we set out to summarise the diagnostic approach in cases of suspected TOS, including the importance of history taking, clinical examination, and the role of investigations at present, and highlight the developments in this field with respect to all subtypes. In the future, we hope that novel diagnostics may be able to stratify patients according to the exact compressive mechanism and thereby suggest more specific treatments and interventions.
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                Author and article information

                Journal
                Diagnostics (Basel)
                Diagnostics (Basel)
                diagnostics
                Diagnostics
                MDPI
                2075-4418
                20 May 2020
                May 2020
                : 10
                : 5
                : 324
                Affiliations
                [1 ]Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; myronrbman@ 123456gmail.com (P.-C.H.); wwtaustin@ 123456yahoo.com.tw (W.-T.W.)
                [2 ]Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
                [3 ]Department of Rehabilitation Medicine, Charles University, First Faculty of Medicine and General University Hospital in Prague, 12800 Prague, Czech Republic; kamal.mezian@ 123456gmail.com
                [4 ]Institute of Anatomy, Charles University, First Faculty of Medicine, 12800 Prague, Czech Republic; ondrej.nanka@ 123456lf1.cuni.cz
                [5 ]Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 11221, Taiwan; yichiang2312@ 123456gmail.com
                [6 ]Center for Anatomy and Cell Biology, Medical University of Vienna and Radiology, Hanusch Hospital, 1090 Vienna, Austria; stefan.meng@ 123456muv.ac.at
                [7 ]Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico Rizzoli Orthopedic Institute, 40136 Bologna, Italy; vincenzo.ricci58@ 123456gmail.com
                [8 ]Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, 06100 Ankara, Turkey; lozcakar@ 123456yahoo.com
                Author notes
                [* ]Correspondence: kvchang011@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-7203-3325
                https://orcid.org/0000-0002-6300-395X
                Article
                diagnostics-10-00324
                10.3390/diagnostics10050324
                7277999
                32443708
                d80a1905-a428-4322-8fb3-0fed5ba54613
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 16 April 2020
                : 18 May 2020
                Categories
                Review

                sonography,neck,brachial plexus,nerve,injury
                sonography, neck, brachial plexus, nerve, injury

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