J Yeungnam Med Sci.  2024 Apr;41(2):120-127. 10.12701/jyms.2024.00087.

Optimal examination for traumatic nerve/muscle injuries in earthquake survivors: a retrospective observational study

• Yalçınkaya B
• Sağ BT
• Aksakal MF
• Analay P
• Ocak H
• Kara M
• Kaymak B
• Özçakar L

• KMID: 2554773
• DOI: http://doi.org/10.12701/jyms.2024.00087

Abstract

Background
Physiatrists are facing with survivors from disasters in both the acute and chronic phases of muscle and nerve injuries. Similar to many other clinical conditions, neuromusculoskeletal ultrasound can play a key role in the management of such cases (with various muscle/nerve injuries) as well. Accordingly, in this article, a recent single-center experience after the Turkey-Syria earthquake will be rendered.
Methods
Ultrasound examinations were performed for various nerve/muscle lesions in 52 earthquake victims referred from different cities. Demographic features, type of injuries, and applied treatment procedures as well as detailed ultrasonographic findings are illustrated.
Results
Of the 52 patients, 19 had incomplete peripheral nerve lesions of the brachial plexus (n=4), lumbosacral plexus (n=1), and upper and lower limbs (n=14).
Conclusion
The ultrasonographic approach during disaster relief is paramount as regards subacute and chronic phases of rehabilitation. Considering technological advances (e.g., portable machines), the use of on-site ultrasound examination in the (very) early phases of disaster response also needs to be on the agenda of medical personnel.

Keyword

Disasters; Entrapment; Neuropathy; Sono-Tinel; Ultrasonography

Figure

• 

  Fig. 1. The patient had healing wound areas on (A) the medial and (B) flexor sides of the right forearm, as well as the dorsum of the hand.

• 

  Fig. 2. (A) Ultrasonographic image shows the dermal/subcutaneous edema (double arrow) and flexor muscles with heterogenous hypo/hyperechoic appearance (dashed area). (B) Long-axis imaging of the forearm illustrates the edematous posterior interosseous nerve (stars) proximal and distal to the compression site (thin arrows). (C) Long-axis imaging also demonstrates the swollen median nerve (asterisks) passing through the heterogenous hypo/hyperechoic flexor muscles (dashed areas).

• 

  Fig. 3. (A) Short-axis ultrasound examination of the brachial plexus (dashed area) at the interscalene region shows swollen nerves (right image) in comparison to the normal side (left image). (B) Long-axis view of the C5 nerve root (asterisks) proximally also shows edema on the involved side (right image) in comparison to the normal side (left image).

• 

  Fig. 4. Short-axis images of (A) the distal arm and (B) proximal forearm depict the swollen radial (arrow) and posterior interosseous (arrow) nerves. BR, brachioradialis; ECRL, extensor carpi radialis longus; S, supinator muscle.

• 

  Fig. 5. (A) Comparative ultrasound imaging over the anterior thigh shows swollen dermis, subcutaneous fat, rectus femoris (RF), and vastus intermedius (VI) muscles on the involved side. (B) Normal side.

• 

  Fig. 6. (A) Axial and (B) longitudinal ultrasonographic images demonstrate the edematous ulnar nerve (arrow and asterisks) passing through Guyon’s canal. UA, ulnar artery; P, pisiform bone.

• 

  Fig. 7. In addition to fascicular edema (arrowheads), cross-sectional area measurements also confirm that the sciatic nerve is swollen (0.79 cm2 vs. 0.60 cm2).

Reference

References

1. Khan F, Amatya B, Gosney J, Rathore FA, Burkle FM Jr. Medical rehabilitation in natural disasters: a review. Arch Phys Med Rehabil. 2015; 96:1709–27.

2. Amatya B, Galea M, Li J, Khan F. Medical rehabilitation in disaster relief: towards a new perspective. J Rehabil Med. 2017; 49:620–8.

3. Dal Zilio L, Ampuero JP. Earthquake doublet in Turkey and Syria. Commun Earth Environ. 2023; 4:71.

4. Wikipedia contributors. 2023 Turkey-Syria earthquake [Internet]. Wikipedia, The Free Encyclopedia;2023. Apr. 26. [cited 2024 Jan 25]. https://en.wikipedia.org/w/index.php?title=2023_Turkey%E2%80%93Syria_earthquake&oldid=1151836296.

5. Ricci V, Ricci C, Cocco G, Gervasoni F, Donati D, Farì G, et al. Histopathology and high-resolution ultrasound imaging for peripheral nerve (injuries). J Neurol. 2022; 269:3663–75.

6. Chang KV, Wu WT, Özçakar L. Ultrasound ımaging and rehabilitation of muscle disorders: Part 1. Traumatic ınjuries. Am J Phys Med Rehabil. 2019; 98:1133–41.

7. Feger J, Bell D. Muscle contusion [Internet]. Radiopaedia.org;[cited 2024 Mar 7]. https://doi.org/10.53347/rID-82383.

8. Ricci V, Özçakar L. Life after ultrasound: are we speaking the same (or a new) language in Physical and Rehabilitation Medicine? J Rehabil Med. 2019; 51:234–5.

9. Özçakar L, Ricci V, Chang KV, Mezian K, Kara M. Musculoskeletal ultrasonography: ninety-nine reasons for physiatrists. Med Ultrason. 2022; 24:137–9.

10. Baloch N, Hasan OH, Jessar MM, Hattori S, Yamada S. “Sports Ultrasound”, advantages, indications and limitations in upper and lower limbs musculoskeletal disorders: review article. Int J Surg. 2018; 54(Pt B):333–40.

11. Cocco G, Ricci V, Villani M, Delli Pizzi A, Izzi J, Mastandrea M, et al. Ultrasound imaging of bone fractures. Insights Imaging. 2022; 13:189.

12. Menorca RM, Fussell TS, Elfar JC. Nerve physiology: mechanisms of injury and recovery. Hand Clin. 2013; 29:317–30.

13. Rathore FA, Gosney JE, Reinhardt JD, Haig AJ, Li J, DeLisa JA. Medical rehabilitation after natural disasters: why, when, and how? Arch Phys Med Rehabil. 2012; 93:1875–81.