Nens van Alfen is an associate professor of Neurology and Clinical
Neurophysiologist from the Radboud university medical center (RUMC) in
Nijmegen, The Netherlands. In 1997 she finished her medical training and she
has been a board certified neurologist since 2004. Dr. van Alfen is the medical
director of the Clinical Neurophysiology laboratory and coordinator of the clinical neurophysiology residency training program. Her areas of expertise are
neuromuscular ultrasound, peripheral nerve pathology and brachial plexus neuropathies, and electrodiagnosis of neuromuscular disorders. The RUMC clinical neurophysiology laboratory performs 1200+ nerve and muscle ultrasound studies yearly, and receives visiting clinicians from all over the world for short training programs in neuromuscular ultrasonography. Dr. van Alfen’s current focus is on advancing muscle ultrasound and developing an international teaching and quality program for neuromuscular ultrasound.

Ultrasound scanners were first used to capture images of peripheral nerve in the early 1990s, but since 2000 there has been an exponentially increasing interest in the use of this imaging modality in disease of peripheral nerve and muscle. Although the earlier observations began with obvious applications in nerve trauma, tumours and local entrapment neuropathies, it has since become apparent that wide variety of inflammatory and inherited polyneuropathies also produce imaging changes in nerve. The field continues to develop apace with ever improving scanners and transducers providing more and more detailed images of peripheral nerve, while ongoing scientific studies around the world are elucidating the characteristic imaging changes in various nerve and muscle pathologies. Ultrasound imaging can be easily combined with nerve conduction and EMG examinations in a single patient visit, providing an integrated anatomical and physiological assessment of a nerve problem.
The single commonest observation is of nerve swelling, which may be focal at an injury or entrapment site, multifocal, usually in inflammatory neuropathies or diffuse in some inherited neuropathies. Other observations may include changes in nerve vascularity seen with doppler imaging, and changes in the mobility of nerves as well as alterations in surrounding tissues which may help to explain localized nerve pathology. There is research interest in the measurement of tissue stiffness (elastography) and contrast enhanced ultrasonography.
The two talks this afternoon will provide a brief guide to how to ‘drive’ an ultrasound scanner, and the basic techniques involved in capturing short and long axis views of peripheral nerves and making measurements. We will illustrate a variety of focal and generalized nerve and muscle imaging abnormalities. In the practical sessions we then aim to give all of the audience who have never used a scanner a chance to experience for themselves, and see how easy this technique is to pick up for those who already have a reasonable grasp of nerve and muscle anatomy.