American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013Results—The mean score (percentage) on the pretest was50.6% (95% confidence interval [CI], 43.5%–57.6%), on the immediateposttest was 66.5% (95% CI, 60.6%–72.4%), and on the 6-month posttestwas 53.5% (95% CI, 45.9%–60.6%). The 6-month posttest scores werenot significantly higher than the pretest scores (P = .505). The immediateposttest scores were significantly higher than the pretest (P = .002) and 6-month posttest (P = .003) scores.Conclusions—This pilot study found that the short-term effectivenessof attending an ultrasound course is supported by higher immediateposttest scores. However, the effectiveness of the course isdiminished in the long term, as the 6-month posttest scores were lowerthan the immediate posttest scores. Although 6-month posttest scores stillremained higher than pretest scores, this was not statistically significant.Our results suggest that the current trend of offering neuromusculoskeletalultrasound courses as an early exposure may have suboptimal benefitsto the learner on its own and may require reinforcement with continuedstructured longitudinal learning opportunities. Future studies done on alarger scale that also correlate testing performance to postcourse ultrasounduse need to be undertaken to further investigate our conclusions.1467503 Utility of Ultrasound for Detecting Anterior CompartmentThickness Changes in Chronic Exertional CompartmentSyndrome: A Pilot StudySathish Rajasekaran, 1 * Cole Beavis, 2 Abdel-Rahman Aly, 1Dave Leswick 3 1 Physical Medicine and Rehabilitation,2Surgery, 3 Diagnostic Imaging, University of Saskatchewan,Saskatoon, Saskatchewan, CanadaObjectives—To test the hypotheses that patients with chronicexertional compartment syndrome (CECS) of the anterior leg compartmenthave an increased anterior compartment thickness (ACT) comparedto controls after exertion using ultrasound.Methods—Four patients with CECS (3 males and 1 female)and 9 controls participated in the study. Our ultrasound technique was firstvalidated with a precision phase (10 controls) prior to scanning study subjects.CECS patients ran on a treadmill until symptomatic (≥5 minutes)using a standardized protocol. ACT and anterior compartment pressureswere measured prior to exercise and at scheduled intervals afterward. Controlsunderwent the same protocol without compartment pressure testing.Results—Anterior compartment pressures were diagnostic ofCECS using the modified Pedowitz criteria in all 4 CECS patients. Themean percent change in ACT from rest in CECS vs controls at 0.5 minuteswas 21.3% (95% confidence interval [CI], 6.92%, 35.6%) vs 6.32% (95%CI, 0.094%, 12.5%; P = .011); at 2.5 minutes, it was 24.6% (95% CI, 10.7%,38.5%) vs 4.22% (95% CI, –1.85%, 10.3%; P = .003); and at 4.5 minutes,it was 24.9% (95% CI, 14.3%, 35.5%) vs 5.08% (95% CI, 0.813%, 11.0%;P = .003). The mean ACT in CECS patients vs controls was significantly increasedafter exertion at 0.5, 2.5, and 4.5 minutes (P = .003).Conclusions—Ultrasound reveals a significant increase in ACTin patients with CECS of the anterior leg compartment compared to controls.Our study shows a promising role for using ultrasound, a noninvasive,readily available, and cost-effective method, to diagnose CECS.Further studies are warranted to validate the findings of this study with agoal of developing anterior leg compartment CECS ultrasound diagnosticcriteria and exploring the role of using ultrasound to diagnose CECSin other compartments.1541063 Efficacy of Sonographically Guided Injections of the CommonPeroneal Nerve Perineural Space at the Fibular TunnelMatthew P Kona, 1 * Oliver Joseph, 1 Oleg Uryasev, 1 John Mc-Namara, 1,2 Apostolos Dallas 1 1 Virginia Tech Carilion Schoolof Medicine, Roanoke, Virginia USA; 2 Jefferson College ofHealth Sciences, Roanoke, Virginia USAObjectives—The common peroneal nerve (CPN) originates asa branch of the sciatic nerve within the popliteal fossa. Continuing inferolaterally,the CPN crosses the fibular head and penetrates the posterior intermuscularseptum, where it courses through the fibular tunnel (FT),defined by the fibula and peroneus longus tendon. CPN entrapment withinthe FT is associated with motor deficits, such as foot drop, as well as sensorydeficits and pain in the distribution of its branches: the anterolateralthird of the lower leg and dorsum of the foot. Treatment may involvesteroid injections into the perineural space of the CPN or its distalbranches. The CPN also serves as a valuable alternative when preoperativesciatic block is unsuccessful or when a faster time to complete blockis desired. The CPN has been effectively imaged using sonography (US).We hypothesize that using sonography, one can effectively inject the CPNperineural space at the FT.Methods—To image the CPN in cross section, 4 cadavericmodels were placed in a prone position, with the transducer over the fibularhead, and rotated 20° from a transverse position. A total of 8 injectionswith methylene blue were performed using an in-plane technique. FT dissectionpermitted classification of injections according to accuracy andprecision. Accuracy referred to nerve staining with methylene blue; precisionreferred to nerve staining without damage to adjacent structures.Results—One hundred percent of injections were accurate,while 87.5% were precise.Conclusions—Limitations of this study stem primarily fromoperator dependence and the pronounced musculoskeletal abnormalitiesof 1 cadaver. In this case, the superficial branch of the CPN was misidentifiedas the CPN. All other injection attempts performed in this study weresuccessful. This study, in conjunction with others designed to investigatethe clinical applications of CPN perineural injections, collectively highlightthe utility of sonography in these relevant patient populations. Futurephases of this study will center on expanding the initial data set and correlatethe accuracy and precision of sonographically guided CPN injectionswith improved patient outcomes.1541082 Efficacy of Sonographically Guided Injections of the UlnarNerve Perineural Space at the Cubital TunnelDaniel Plessl, 1 * Robert Summey, 1 Oliver Joseph, 1 OlegUryasev, 1 John McNamara, 1,2 Apostolos Dallas 1 1 VirginiaTech Carilion School of Medicine, Roanoke, Virginia USA;2Jefferson College of Health Sciences, Roanoke, Virginia USAObjectives—Ulnar nerve (UN) entrapment is the second mostcommon nerve entrapment of the upper limb. The most common entrapmentsite is at the cubital tunnel to produce cubital tunnel syndrome (CTS).At the elbow, the UN courses subcutaneously between the medial epicondyleand the olecranon in the condylar groove and then enters the cubitaltunnel. CTS presents with medial elbow pain and varying symptomsfrom sensory complaints to weakness of intrinsic hand muscles. CTS maybe caused by extrinsic compression of the UN, bone deformities, or softtissue lesions. The cubital tunnel has been effectively imaged using sonography;however, clinical benefits of such imaging have yet to be confirmed.We hypothesize that, using sonography, one can effectively injectthe UN perineural space at the cubital tunnel.Methods—In this pilot study, the UN was visualized bilaterallyon 4 nonembalmed cadaveric models. The elbow was examined in externalrotation, and the transducer was placed transverse to the condylargroove along the medial epicondyle-olecranon axis. Sonographicallyguided lateral-to-medial UN injections with 0.35 mL of methylene blueS23
American Institute of Ultrasound in Medicine <strong>Proceedings</strong> J Ultrasound Med 32(suppl):S1–S134, 2013were performed. Incisions were made parallel to the condylar groove deepto the cubital tunnel retinaculum to expose the underlying UN. Injectionswere accurate if the UN perineural space was dyed, and they were preciseif the injection did not damage adjacent anatomy.Results—Eight of 8 injections were both accurate and precise.Conclusions—UN perineural injection is significant as it canprovide symptomatic relief for CTS with corticosteroid injections toreduce inflammation. Sonography is inexpensive, quick, and minimallyinvasive. Future phases of this study will investigate efficacy of sonographicallyguided UN perineural corticosteroid injections in patients withCTS. This study suggests that injections under sonographic guidance areaccurate and precise, therefore serving as a potential adjunct to treatmentthat is worth further investigation. Future phases of this study will centeron expanding the initial data set and correlate the accuracy and precisionof injection with improved patient outcomes.1539088 Translating Contrast-Enhanced Ultrasound IntraneuralVascularity From Bench to BedsideKevin Evans,* Kevin Volz School of Health and RehabilitationSciences, Ohio State University, Columbus, Ohio USAObjectives—To describe contrast-enhanced ultrasound (CEUS)imaging of the human median nerve’s intraneural vascularity, with equipmentsettings and optimizations derived from experiments with a cohortof Macaca fascicularis.Methods—The equipment used was a GE LOGIQ 9, completewith contrast settings, and a GE LOGIQ i, which is considered a handcarriedunit. A 9.0-MHz linear broadband transducer was used with theGE LOGIQ 9, and a 12.0-MHz linear broadband transducer was used withthe GE LOGIQ i hand-carried unit. Definity was used for this study becauseit possesses the smallest microspheres, 1.1 to 1.3 µm, has stabilityof
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