Ultrasonographic evaluation of tibial nerve in diabetic peripheral neuropathy
Dr. Nitu, Dr. Ravi Kumar, Dr. Sanjay Kumar Jha, Dr. Rajeev Ranjan
One of the major complications of diabetes mellitus is peripheral neuropathy with reported prevalence of approximately 25%. The pathophysiology of DPN is multifactorial and involves genetic, metabolic and vascular factors. Diabetes induced endothelial dysfunction with a resultant decrease in nerve blood flow (vasa nervorum) plays a key role in axonal degeneration, demyelination of nerve fibre. Hyperglycemia includes increased metabolic flux through the polyol pathway with consequent sorbitol and fructose accumulation in DPN. High-resolution ultrasound is the most commonly used imaging modality because it is inexpensive, provides high resolution, is readily available and allows for dynamic imaging. Most studies suggest that the key ultrasonographic finding is enlargement of the tibial nerve in diabetic peripheral neuropathy. Hence the present study was planned with aims of study was to evaluate the cross sectional area and maximum thickness of nerve fascicles of the tibial nerve in patients of diabetic peripheral neuropathy by using high resolution ultrasound. Total 30 cases of the diabetic peripheral neuropathy (DPN) were enrolled as cases in Group A and in Group B 20 cases of the control patients without any indications of diabetes and peripheral neuropathy. The patients were examined in supine position with lateral rotation of foot. The transducer was placed 3cm above the medial malleolus to locate the tibial nerve in the transverse (short axis) and in the longitudinal (long axis) axis by using GE LOGIQ P5 ultrasound machine. The cross sectional area of tibial nerve was taken by manual tracing was used for tibial nerve scanning. From the findings of present study it can be concluded that the cross sectional areas and maximum thickness of nerve fascicles of the tibial nerve is larger in type 2 diabetic patients with peripheral neuropathy than those of healthy control cases and sonographic examinations are very useful for the early diagnosis of diabetic neuropathy. Early detection of nerve dysfunction is important to provide appropriate care for patients with diabetic polyneuropathy.