Journal CME, April 2023: Diagnostic ultrasound of the residual limb: A narrative review-Journal CME, April 2023: Diagnostic ultrasound of the residual limb: A narrative review

Journal CME, April 2023: Diagnostic ultrasound of the residual limb: A narrative review

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In a narrative review by Powell, Sparling, and Yuan, the utility of diagnostic ultrasound for assessing residual limb pain post-amputation is explored. The prevalence of traumatic limb loss worldwide was noted as 57.7 million people in 2017, with an estimated increase in the U.S. to 3.6 million by 2050. Residual limb pain (RLP), which affects up to 59% of amputees, is often challenging to diagnose using conventional methods.<br /><br />The review analyzed 31 peer-reviewed articles from 1989 to 2021. Key findings indicate that ultrasound is beneficial for identifying various pathologies in residual limbs, including neuromas, soft tissue abnormalities, vascular abnormalities, bone/cartilage abnormalities, and muscle/nerve changes. However, the literature reveals significant gaps and lacks standardized protocols for sonographic assessment.<br /><br />### Key Pathologies and Ultrasound Findings:<br />1. **Neuromas:** These are well-circumscribed, hypoechoic masses commonly found at the end of severed nerves and are detectable using sonopalpation to distinguish between symptomatic and asymptomatic cases.<br />2. **Soft Tissue Abnormalities:** Conditions like seromas, adventitious bursitis, and subcutaneous edema are identifiable via ultrasound, although descriptions are often vague. Specific, detailed protocols are not available.<br />3. **Vascular Abnormalities:** Deep vein thrombosis (DVT) detection in residual limbs via duplex ultrasound is standard, though application in amputee populations lacks special guidelines. Other vascular issues may also be assessed using ultrasound.<br />4. **Bone and Cartilage Abnormalities and Heterotopic Ossification (HO):** Early stages of HO are detectable with ultrasound, providing an advantage over other imaging modalities that cannot identify HO until weeks later. Osteophytes and cartilage abnormalities are also identifiable.<br />5. **Muscle and Nerve Changes:** Ultrasound can measure muscle atrophy and fibrosis, as well as cross-sectional areas of nerves. However, normative data for these measures post-amputation is unavailable.<br /><br />### Conclusion:<br />Ultrasound is a promising tool for diagnosing residual limb pathology due to its cost-effectiveness and bedside availability. However, there is a critical need for more research to establish standardized protocols, define the sonographic criteria of various pathologies, and improve diagnostic accuracy through better training and experience. Significant gaps in understanding and technique remain, especially concerning the evaluation of sensory nerve neuromas and normative data for muscle and nerve changes post-amputation.

Keywords

diagnostic ultrasound

residual limb pain

amputation

neuromas

soft tissue abnormalities

vascular abnormalities

bone cartilage abnormalities

muscle nerve changes

heterotopic ossification

standardized protocols