The application of ultrasound, specifically to disorders of the nerve and muscle by neurologists, is relatively recent, and few centers have seriously incorporated this technology into the clinical setting. Our group has employed neuromuscular ultrasound (NMUS) as an adjunct to electrodiagnostic testing for the past eight years and found it helpful in aiding the diagnosis and management of neuromuscular disorders.

On the topic of NMUS, Steven Herskovitz, MD, and his team recently published on a little known and uncommon cause of entrapment neuropathy in a paper titled “Nerve entrapments related to muscle herniation.” Muscle herniation, a rarely reported cause of peripheral nerve entrapment, occurs when muscle protrudes through an acquired or congenital fascial defect. These herniations can compress adjacent peripheral nerves with resultant neurological deficits. 

Dr. Herskovitz’s report presented a case of superficial fibular (peroneal) neuropathy related to fibularis (peroneus) brevis muscle herniation and reviewed the existing literature on nerve entrapments secondary to muscle herniation. In this study, patients present with pain, numbness or paresthesias, and an often tender, small, palpable mass with a Tinel’s sign.