Post-COVID pain or weakness? Request an ultrasound or MRI
Advanced imaging can diagnose nerve/muscle injuries and guide treatment decisions

Date:
December 1, 2020
Source:
Northwestern University
Summary:
A new study shows how advanced imaging technology can pinpoint
what may have caused patients' nerve damage and help determine
the best course of treatment.



FULL STORY ========================================================================== After recovering from COVID-19, some patients are left with chronic, debilitating pain, numbness or weakness in their hands, feet, arms and
legs due to unexplained nerve damage. A new Northwestern Medicine study
shows how advanced imaging technology can pinpoint what may have caused patients' nerve damage and help determine the best course of treatment.


========================================================================== "Let's say you have numbness in your fingers. That might actually be due
to problems in your neck, elbow or wrist, and the best way to figure it
out is with an MRI or ultrasound," said lead author Dr. Swati Deshmukh, assistant professor of radiology at Northwestern University Feinberg
School of Medicine and a Northwestern Medicine radiologist. "We offer
advanced imaging that shows even really, really small nerves, which helps
us localize where the problem is, assess the severity and suggest what
might be causing it." This is the first known publication to summarize
how these advanced imaging techniques can help physicians identify and
treat nerve damage in COVID-19 patients. The study will be published
December 1 in the journal Radiology.

Two New Causes of Nerve Damage Previous research from Northwestern and
Shirley Ryan AbilityLab found COVID-19 patients can experience nerve
damage after being flipped onto their stomachs (prone positioning)
in the ICU as a life-saving measure to help them breathe.

This new paper demonstrates how advanced imaging aids this cohort of
patients as well as two additional patient cohorts with COVID-19-related
nerve damage:
* Secondary to an inflammatory immune response that attacked the
nerves or * From a hematoma (when blood collects outside of the
blood vessels).

"Similar to how the body's immune response attacks the lungs in severe
COVID cases, some patients have an immune response that affects their
nerves," Deshmukh said. "Another group of patients developed hematomas as
a complication from the blood thinners they were treated with when they
had COVID." Deshmukh said she hopes the findings will raise awareness
of this imaging technology.



==========================================================================
"I have to wonder if there are physicians out there who are seeing these otherwise young, healthy patients, and they don't know exactly what's
wrong and they're thinking, 'What am I supposed to do for patients with post-COVID pain and weakness?'" Deshmukh said. "I want physicians and
patients to be aware of the diagnostic options available due to recent innovations in technology, and inquire if advanced imaging might be
right for them." How the Technology Works The imaging described in
the paper includes ultra-high-resolution ultrasound and MR neurography
(MRI of peripheral nerves, which impact the arms and legs).

They can help localize where a patient's problem is, show the severity
of nerve damage, how many nerves are affected and if the nerve damage
also has impacted the muscles.

The advanced ultrasound technology is new, portable, less expensive
and can sometimes be even better at detecting nerve damage than MRI,
Deshmukh said.

Ultrasound also can be performed on patients who are unable to tolerate
MR imaging.

Guiding Treatment Decisions If imaging technology discovers nerve
damage caused by stretch injury because of prone positioning, Deshmukh
said, that patient may be referred to a physician who specializes in rehabilitation or peripheral nerve surgery. If imaging finds nerve damage
due to an inflammatory response, the patient may be better served by
seeing a neurologist. If imaging reveals nerve damage from a hematoma,
blood thinner medications would have to be adjusted immediately and the
patient may even have to see a surgeon.



==========================================================================
For COVID-19 patients and survivors with neuromuscular complications or
"long- hauler" symptoms, imaging can help reveal the problem and guide
further treatment.

All patients in the study had tested positive for COVID-19.

Other Northwestern study authors include Dr. Colin K. Franz , Dr. Jason
H. Ko, Dr. James M. Walter and Dr. Igor J. Koralnik from the departments
of physical medicine and rehabilitation, neurology, plastic and
reconstructive surgery, and pulmonary and critical care, respectively.


========================================================================== Story Source: Materials provided by Northwestern_University. Original
written by Kristin Samuelson. Note: Content may be edited for style
and length.


========================================================================== Journal Reference:
1. Claire E. Fernandez, Colin K. Franz, Jason H. Ko, James M. Walter,
Igor
J. Koralnik, Shivani Ahlawat, Swati Deshmukh. Imaging Review of
Peripheral Nerve Injuries in Patients with COVID-19. Radiology,
2020; 203116 DOI: 10.1148/radiol.2020203116 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/12/201201103618.htm

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