Ultrasound Replacing Electrodiagnostics?

[kurt rambis]

Wanted to get everyone's thoughts on the future of electrodiagnostics and imaging particularly ultrasound and particularly for entrapment neuropathies. Electrodiagnostics are in my opinion one of the most interesting things we do as physiatrists but it doesn't seem that there have been any major advances or new uses for it recently. Do you all see electrodiagnostics playing the same role in the next 10 years in diagnosing things like entrapment neuropathy?

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[Diamox]

For entrapment? We'll see what the literature starts to show.
For everything else? (radics, plexus, myelopathy, etc) it will never die.

 

[PMR 4 MSK]

From what I've seen of ultrasound, it can show deformation of nerves such as the median nerve in the carpal tunnel, possibly other nerves as well. Whether that truely correlates with CTS reamins to be seen. It will not, however, be able to show demylination vs axonal loss, nor denervation, all important measures.

It will not likely help with polyneuropathies, NMJ Disorders, radics, etc. Might be of some use in some myopathies.

The problem is it is very technician-dependent and it is a very steep learning curve. Docs are excited at the prospect of a new imaging tool, but so much research needs to be done.

 

[Ludicolo]

Admittedly, I am currently near the bottom of the US learning curve. But I don’t think US will replace EMG. I see them as complimentary tests, as one is primarily a test of anatomy/causation, and the other is a primarily a test of physiology/function. It will be interesting to see what happens as more of us get better and more proficient w/ US.

Most of the studies comparing the two are in CTS. Correlates are still being defined. Just from a practical standpoint, I would imagine that US is more time efficient than inching in terms of localization. US is probably more comfortable for the patient. With regards to polyneuropathies, US may be able to demonstrate denervated muscle with fatty infiltration, may demonstrate hypertrophic nerves in some hereditary neuropathies, or peripheral nerve inflammation. But these findings seem rather non-specific.

There is a cool case report out of Mayo in the latest Muscle and Nerve demonstrating US guided needle EMG of the diaphragm.