Spatial variation in mechanical properties along the sciatic and tibial nerves: An ultrasound shear wave elastography study

Ultrasound shear wave elastography has become a promising method in peripheral neuropathy evaluation. Shear wave velocity, a surrogate measure of stiffness, tends to increase in peripheral neuropathies regardless of etiology. However, little is known about the spatial variation in shear wave velocity of healthy peripheral nerves and how tensile loading is distributed along their course. Sixty healthy young adults were scanned using ultrasound shear wave elastography. Five regions of the sciatic (Sciatic PROXIMAL, Sciatic DISTAL) and tibial nerve (Tibial PROXIMAL, Tibial INTERMEDIATE, and Tibial DISTAL) were assessed in two hip positions that alter nerve tension: 1) neutral in supine position; and 2) flexed at 90 degrees. Knee and ankle remained in full-extension and neutral position. We observed spatial variations in shear wave velocity along the sciatic and tibial nerve (P < 0.0001). Shear wave velocities were significantly different between all nerve locations with the exception of Sciatic DISTAL vs. Tibial INTERMEDIATE (P = 0.999) and Tibial PROXIMAL vs. Tibial INTERMEDIATE (P = 0.708), and tended to increase in the proximal-distal direction at both upper and lower leg segments. Shear wave velocity increased with hip flexion (+54.3%; P < 0.0001), but the increase was not different among nerve locations (P = 0.233). This suggests that the increase in tensile loading with hip flexion is uniformally distributed along the nerve tract. These results highlight the importance of considering both limb position and transducer location for biomechanical and clinical assessments of peripheral nerve stiffness. These findings provide evidence about how tension is distributed along the course of sciatic and tibial nerves.