RSD from Nerve Entrapment

Entrapment: Complex Regional Nerve Pain After Trauma

Animation: Sciatic nerve hyperintensity associated with adhesion to a site of pelvic fracture.

(A)  Sciatic nerve hyperintensity associated with adhesion to a site of pelvic fracture in a patient with new onset reflex sympathetic dystrophy (RSD). The RSD symptoms resolved after nerve release surgery.

(B) Deformation in the shape of the sciatic nerve at a site of prior trauma and failed surgical exploration.

(B1) This reconstruction in the sagittal plane shows a flattened sciatic nerve with an irregular course instead of the expected straight smooth course.

(B2) In the coronal view the sciatic nerve is broad and flat. The two images together show the severe mechanical distortion of the nerve at this site of adhesion. After four years of failed intensive pain management, the symptoms were relieved by nerve release surgery.

Diagnosis of Unusual Entrapments

Entrapment: Imaging for Diagnosis of Unusual Entrapments

Animation: Marked hyperintensity of the recurrent branch.

This animation depicts severe impingement syndrome affecting the recurrent branch of the median nerve in the wrist.

A 62-year-old woman suffered severe denervation of thenar muscles with no other symptoms of carpal tunnel syndrome after casting for a wrist fracture.

The image demonstrates marked hyperintensity of the recurrent branch as it separates from the median nerve.

Normal Mobility of Median Nerve

Entrapment: Movement of Nerves Across Joints Can Become Impaired

Animation: Joint nerve movement.

(A)  The median nerve (mn) at the wrist located near the palmar aspect of the carpal tunnel with the tendons (te) posterior to it.

(B) The median nerve is posterior to the tendon in this image. A & B are images of the same individual at the same location in the hand but, image A is obtained with the wrist in flexion and image B is obtained in extension.

Repair of Peroneal Nerve Laceration

Entrapment: Repair of Severed Nerve

Animation: Two views of a post-operative neuroma at site of failed nerve repair.

This animation depicts two views of a post-operative neuroma at the site of a failed nerve repair in a lacerated peroneal nerve.

The use of imaging to monitor the progress of a nerve repair may allow time to correct any problems with the initial repair.

Suture repair of nerves often provides an opportunity to recover function after severe trauma. Currently the introduction of nerve tubes for the repair of severed nerves has led to a great reduction in the length of surgical operations for nerve repair and has led to improved resutls for recovery and regrowth of severed nerves.