Bypassing the challenges of lower-limb electromyography by using ultrasonography: AnatoMUS-II.

Electrodiagnostic studies are the gold-standard evaluation tools for peripheral nerve entrapment syndromes. However, although they can indirectly localize the site of injury (through physiological data), they cannot provide morphological confirmation as do other imaging methods (1). Furthermore, during lower limb diagnostics in particular, electrophysiologists may encounter various challenges concerning certain entrapment syndromes, e.g. meralgia paraesthetica, tarsal tunnel syndrome, Morton’s neuroma. In addition, technical difficulties during sensory evaluations with surface electrodes (even with near-nerve needle techniques) may overwhelm the diagnostics (2–5). In this case, ultrasound appears to be a very convenient, real-time imaging tool, whereby it is practical for the physician to scan several peripheral nerves immediately after medical/ physical examination of the patient. In addition, in the aforementioned challenging cases, it becomes a powerful diagnostic tool rather than merely an adjunct to electrodiagnostics. With ultrasound, one can morphologically confirm entrapment, uncover the underlying cause of injury, precisely guide onward intervention (injection/surgery), and follow up the injury (1). Thus, having organized study of the upper limb in 2012 (6), in a similar workshop in 2013 we studied the lower limb nerves in parallel sessions using cadavers and ultrasound (Fig. 1). This time we included in-depth electrophysiological discussion BypassIng THE CHallEngEs oF loWEr-lImB ElECTromyograpHy By UsIng UlTrasonograpHy: anaTomUs-II