High Resolution Ultrasound in Combat-Related Peripheral Nerve Injuries: A Case Series (P6.083)

OBJECTIVE: To describe and compare electrodiagnosis and high resolution ultrasound (US) in evaluation of traumatic peripheral nerve injuries (PNI) in combat-related extremity injuries. BACKGROUND: Up to 25% of wartime extremity trauma involves PNI, but extensive soft tissue damage and distorted anatomy complicate diagnostic studies and retained foreign bodies often preclude MRI. Padua et al. (2013) reported that US modifies the electrodiagnostic conclusions and resulting therapeutic strategies in 58% of traumatic PNI, but the technique is not well studied in combat-related PNI, which often involve massive extremity trauma. DESIGN: We describe clinical, electrodiagnostic, and US findings in three cases of combat-related PNI, all of which underwent surgical exploration. RESULTS: 4 upper extremity PNI (3 ulnar, 1 median) were included in 3 male patients. Mechanism of injury included high velocity gunshot wound (n=1) and rocket-propelled grenade blasts. Case 1: Electrodiagnosis disclosed a complete median neuropathy in the forearm and a non-localizing ulnar neuropathy. US demonstrated median nerve discontinuity with a proximal neuroma distal to the elbow crease. Ulnar US demonstrated focal enlargement and hypoechogenicity suggestive of neuroma-in-continuity distal to the medial epicondyle. Both findings were confirmed surgically. Case 2: Electrodiangosis suggested an incomplete ulnar neuropathy with conduction block across the elbow versus transection and proximal Martin-Gruber anastomosis, but extensive electromyographic abnormalities indistinguishable from existing muscle trauma precluded further interpretation. US demonstrated ulnar discontinuity and a proximal neuroma above the elbow; findings were confirmed surgically. Case3: Electrodiagnosis disclosed a non- localizing complete ulnar neuropathy. US demonstrated an ulnar discontinuity 4cm proximal to the wrist; findings were confirmed surgically. CONCLUSIONS: High resolution US provides additional localization and severity data when combined with electrodiagnosis in combat-related PNI, and can be obtained in patients who cannot undergo MRI. Disclosure: Dr. Smith has nothing to disclose. Dr. Miller has nothing to disclose. Dr. Carroll has nothing to disclose. Dr. Faillace has nothing to disclose. Dr. Nesti has nothing to disclose. Dr. Cawley has nothing to disclose. Dr. Landau has nothing to disclose.