Submitted by: Elliot Bodofsky, MD
Edited by: Rocio Carolina Garcia Santibanez, MD
Grimm A, Axer H, Bianka H, Winter N. (2018). Nerve ultrasound normal values - Readjustment of the ultrasound pattern sum score UPSS. Clinical Neurophysiology
Ultrasound nerve cross sectional areas were carefully measured unilaterally in 100 normal volunteers. The goal was to improve ultrasound diagnosis of peripheral neuropathy by setting cutoff values for the UPSS, a summation score for nerve enlargement. Patients with a history of neuromuscular disorders, diabetes, or use of neurotoxic medications were excluded, and all had a normal neurologic exam. The median nerve was evaluated at four locations, ulnar at three, the superficial radial, tibial, and peroneal at two locations, the sural and vagus nerves, C5 and C6 nerve roots at one location. Data was analyzed by gender, age, height and weight.
There were relatively few significant differences. Males had significantly larger cross sectional area in the proximal and distal tibial nerve (8 and 13%), and the proximal median nerve (7%). Areas of the distal median nerve and the proximal tibial nerve increased significantly with age. Only the cross sectional area of the tibial nerve increased with height. No nerves showed significant correlation with weight. Most values were similar to previous studies. More gender related differences had been observed in some previous studies.
Overall, median and tibial nerve cross sectional areas must be adjusted for age and gender. The tibial nerve cross sectional area should also be adjusted for height.
Overall this was a well-designed study of the ultrasound cross sectional area of many commonly evaluated nerves in a normal population, analyzed by gender, height, weight and age. There were surprisingly few significant differences. Of note, while there was a large age range in this study, height and weight showed modest variation (80% of subjects were 60-90 Kg). It is not clear whether these values would apply for unusually short, tall, thin, or heavy patients. The data from this study can be used to improve diagnosis of peripheral neuropathies.