Authors' Response to the Letter to the Editor on "Ultrasonography in Pronator Teres Syndrome: Dynamic Examination and Guided Hydrodissection"
Journal
Pain medicine (Malden, Mass.)
Journal Volume
23
Journal Issue
1
Pages
223-224
Date Issued
2022
Author(s)
Abstract
Dear Editor, We appreciated the valuable comments from Dr. Lam and his team on our article entitled “Ultrasonography in Pronator Teres Syndrome: Dynamic Examination and Guided Hydrodissection” [1]. Like what the authors mentioned, ultrasound (US) is useful in delineating peripheral neuropathy [2]. Static US imaging like measurements of the nerve cross-sectional area eases serial follow-up of the same patients and comparisons among different individuals, whereas dynamic US imaging enables the early detection of perineural adhesion and abnormal nerve excursion during limb motions. We are grateful for the authors to highlight the application of dynamic US on diagnosis of neuromuscular disorders. Regarding the interface of adhesion, we agree with Lam et al. that it could occur at the ventral and dorsal halves of the epineurium of the median nerve. The speculation could be evident on Figure 1B of the commented article [1], which revealed hyperechoic with atrophic changes over the humeral and ulnar heads of the pronator teres muscles. We also acknowledge that if the undersurface of the median nerve and the upper surface of the ulnar head of the pronator teres had been hydrodissected, the patient might achieve faster recovery with fewer treatment sessions.
Publisher
NLM (Medline)
Type
letter