Daniel W. Haun

Normative cross-sectional area of the C5-C8 nerve roots using ultrasonography.

This study will define a normal range of values for the cross-sectional area (CSA) of the C5-C8 ventral rami in normal subjects and will assess the interexaminer reliability of the CSA measurements. We also describe the normal sonoanatomy of the C5-C8 ventral rami. Thirty-three normal subjects (20 female) were scanned bilaterally. The mean CSA and reference ranges for the C5, C6, C7 and C8 ventral rami were 7.1 +/- 4.1 mm(2), 10.6 +/- 4.3 mm(2), 12.1 +/- 4.1 mm(2) and 10.7 +/- 4.8 mm(2), respectively. The intraclass correlation coefficient (ICC) demonstrated good reliability with a coefficient of 0.76 overall, with individual level coefficients at C5, C6, C7 and C8 of 0.69, 0.71, 0.76 and 0.72, respectively. This is the first study to obtain normative CSA measurements of the C5-C8 ventral rami.

Spondylolysis and spondylolisthesis: a narrative review of etiology, diagnosis, and conservative management

OBJECTIVE To review current literature regarding the etiology, diagnosis, and conservative treatment of spondylolysis and spondylolytic spondylolisthesis. METHODS The PubMed database was searched for articles on spondylolysis and/or spondylolisthesis and their incidence, diagnosis, imaging, treatment, and prognosis. The bibliographies of articles determined to be relevant were also reviewed. RESULTS A PubMed search of spondylolysis or spondylolis-thesis yielded over 800 citations. Sixty-eight articles were selected based on an opinion of perceived relevance to the subjects of spondylolysis and spondylolisthesis. CONCLUSIONS Spondylolysis affects approximately 6% of the population. The lesion likely represents a stress fracture and the typical age of onset is early childhood and adolescence. Most individuals are asymptomatic. Adolescents with low back pain may have an impending or new pars defect. A high index of suspicion for a new pars defect should prompt utilization of physiologic imaging to determine the likelihood of pars union in young patients. Restrictive bracing may lead to healing of the fracture and cessation of pain. Spondylolisthesis is a common complication of spondylolysis. Spondylolisthesis progression is typically small and most likely in young individuals. Significant progression in adults is rare. The finding of spondylolysis and spondylolisthesis in an adult patient is usually incidental and not likely to be a direct source of pain unless there is concurrent instability.

Sonographic Evaluation of the Greater Occipital Nerve in Unilateral Occipital Neuralgia

Occipital neuralgia is a headache that may result from greater occipital nerve entrapment. Entrapped peripheral nerves typically have an increase in cross‐sectional area. The purpose of this study was to measure the cross‐sectional area and circumference of symptomatic and asymptomatic greater occipital nerves in patients with unilateral occipital neuralgia and to correlate the greater occipital nerve cross‐sectional area with headache severity, sex, and body mass index.

Normative Cross-Sectional Area of the Brachial Plexus and Subclavian Artery Using Ultrasonography

OBJECTIVE Ultrasonography has been used to measure the cross-sectional area (CSA) of peripheral nerves, but the CSA of the brachial plexus has not previously been reported. The purpose of this study was to establish a reference range of values for the CSA of the brachial plexus, subclavian artery, and peak systolic velocity (PSV) of the subclavian artery in healthy subjects using ultrasonography. METHODS Thirty-two asymptomatic subjects (19 men, 13 women) from a chiropractic college with an average age of 29.5 +/- 9.6 participated in the study. The brachial plexus and subclavian artery CSA were measured at 3 locations: interscalene, first rib, and infraclavicular. The PSV of the subclavian artery was measured in both supraclavicular and infraclavicular locations. Each subject was imaged bilaterally. Means and 95% confidence intervals were calculated. Interexaminer reliability was evaluated between 2 examiners on 15 randomly selected subjects. RESULTS The average CSA for the brachial plexus at the interscalene space, first rib, and infraclavicular location was 0.75 +/- 0.05, 0.96 +/- 0.07, and 0.98 +/- 0.07 cm(2), respectively. The average CSA for the subclavian artery at the same locations was 0.35 +/- 0.03, 0.38 +/- 0.03, 0.35 +/- 0.03 cm(2), respectively. The average subclavian artery PSV in supraclavicular and infraclavicular locations was 98 +/- 8 and 93 +/- 7 cm/s, respectively. The overall interexaminer reliability was poor at 0.39 (0.20-0.55). CONCLUSIONS This is the first study to obtain normative CSA measurements of the brachial plexus and subclavian artery in multiple locations of the thoracic outlet as well as interexaminer reliability data. These data may be beneficial in future studies designed to assess the brachial plexus and subclavian artery in patients with thoracic outlet syndrome.

Sonography of the normal greater occipital nerve and obliquus capitis inferior muscle.

To use sonography to measure the cross‐sectional area (CSA) of the greater occipital nerve (GON) and the adjacent obliquus capitis inferior muscle (OCI) in normal subjects.

Symptomatic plantar fibroma with a unique sonographic appearance.

We present a case of a solitary plantar fibroma with unique sonographic features with MRI and pathologic correlation. A 25‐year‐old woman presented with a left foot mass that interfered with her gait. Sonography demonstrated a well‐circumscribed, 32 mm × 27 mm × 14 mm subcutaneous mass with heterogeneous echogenicity. Unique sonographic characteristics included posterior acoustic enhancement, cystic components, and mild intratumoral hypervascularity. MRI confirmed the sonographic findings. Surgical excision was performed without complication. A pathologic diagnosis of fibroma with myxoid degeneration and cyst formation was made.

Sonographic measurement of the normal suprascapular nerve and omohyoid muscle.

The aim of this study was to obtain normative ultrasonography (US) data on the suprascapular nerve (SSN) and omohyoid muscle (OM) in the lateral cervical region. The SSN and OM are known to be related throughout the nerves course, yet little imaging data exists on these structures at areas more proximal than the suprascapular foramen. US data from a convenience sample of 33 asymptomatic subjects between 21 and 42 years of age were collected. Cross sectional area (CSA) of the SSN, distances from the OM to the SSN, and long-axis diameter of the OM at three reference points were obtained. The mean CSA of the SSN at both its origin and over the first rib was 1.9 mm2 and at the distal clavicle was 2.0 mm2. The mean distance of the OM to the SSN at these locations was 7.6 mm, 4.2 mm and 2.8 mm respectively. The mean long axis diameter of the OM was 2.4 mm at the SSN origin, 3.4 mm at the first rib, and 4.1 mm at the distal clavicle. We present US data from asymptomatic subjects on the SSN and OM. Our results show that the SSN nerve CSA is consistent throughout the nerves proximal course. Furthermore, the OM and SSN tend to approximate as they course distally. Future studies with larger samples will better characterize the normal sonoanatomy of these structures between genders and across different ages.

Use of high-resolution ultrasound to measure changes in plantar fascia thickness resulting from tissue creep in runners and walkers.

OBJECTIVE This study sought to use high-resolution ultrasound to measure changes in plantar fascia thickness as a result of tissue creep generated by walking and running. METHODS Independent samples of participants were obtained. Thirty-six walkers and 25 runners walked on a treadmill for 10 minutes or ran for 30 minutes, respectively. Standardized measures of the thickness of the plantar fascia were obtained in both groups using high-resolution ultrasound. RESULTS The mean thickness of the plantar fascia was measured immediately before and after participation. The mean plantar fascia thickness was decreased by 0.06 ± 0.33 mm SD after running and 0.03 ± 0.22 mm SD after walking. The difference between groups was not significant. CONCLUSION Although the parameters of this study did not produce significant changes in the plantar fascia thickness, a slightly higher change in the mean thickness of the plantar fascia in the running group deserves further investigation.

Ultrasound measurements of lumbar multifidus and abdominal muscle size in firefighters

BACKGROUND Firefighters have a high incidence of low back pain and injury. OBJECTIVE To describe lumbar multifidus and abdominal muscle size characteristics in firefighters and to compare these characteristics to normative reference ranges. METHODS In career firefighters without current low back pain (62 males, 7 females), ultrasonography was used to assess: L4 and L5 lumbar multifidus cross-sectional area (CSA), asymmetry, and thicknesses; and external oblique, internal oblique, and transverse abdominal thicknesses. Comparisons of mean values in firefighters were made to the normative 95% reference ranges for the general population and soldiers. RESULTS Mean values for lumbar multifidus and abdominal muscle size in firefighters fell within the 95% reference ranges for the general population and soldiers for all measurements, except L4 multifidus CSA in males and L5 multifidus CSA in females, which were larger in firefighters than the general population. CONCLUSIONS The majority of lumbar multifidus and abdominal muscle size measurements in firefighters are similar to the general population and soldiers. The larger lumbar multifidus CSA in firefighters compared with the general population warrants further study. These data provide a basis for future research using ultrasonography to assess muscle size in firefighters and other workers in physically-demanding occupations.

Patellar Dislocation in a 16-Year-Old Athlete With Femoral Trochlear Dysplasia

OBJECTIVE This case report discusses the diagnosis and conservative management of a patient with femoral trochlear dysplasia (FTD) and subacute patellar dislocation. Femoral trochlear dysplasia is characterized by an abnormally shallow trochlear groove. Disengagement of the patella from the shallow femoral trochlea is common in FTD and is a predisposing risk factor to recurrent patellar dislocation and subsequent premature osteoarthrosis. Accurate diagnosis is necessary to prevent recurrent patellar dislocations and damage of the patellofemoral joint cartilage and supporting structures. CLINICAL FEATURES A 16-year-old male adolescent presented with pain, ecchymosis, and swelling about the right anterior knee approximately one month after a self-described dislocating event. Clinical and imaging findings, including magnetic resonance imaging and ultrasonography, demonstrated evidence of patellar dislocation with previously undiagnosed FTD. INTERVENTION AND OUTCOME After drainage of the knee effusion at a local hospital, the patient underwent a chiropractic treatment protocol consisting of stabilization with patellar tracking orthosis, customized orthotic support, and various muscular stabilization and strengthening exercises. After 6 weeks of treatment, the swelling and ecchymosis resolved. The knee ranges of motion were full without pain. Although the hypermobility of the patella demonstrated no interval change, the patient reported improved strength and stability of the right knee. CONCLUSION This case highlights a young athlete with subacute patellar dislocation and FTD who responded successfully to conservative management. Conservative stabilization and strengthening protocols improved patient outcome without surgical repair of the underlying FTD. Conservative management of FTD has not been reported and it makes the current case unique. However, the long-term outcome of conservative management is unknown at this point and further studies are necessary to evaluate treatment protocols.