Сонографічне оцінювання болючих кукс: діагностичні патерни резидуального болю кінцівки після ампутації

Residual limb pain (RLP) is a common disabling complication of amputation. RLP etiologies are multifactorial, including neuromas, heterotopic ossification (HO), infection, scar tissue, and prosthesis-related complications. While magnetic resonance imaging and computed tomography are useful, ultrasound (US) is uniquely accessible, dynamic, and cost-effective for bedside evaluation. We selected US for screening RLP because it provides high-sensitivity, high-specificity bedside visualization of superficial and peristump/periprosthetic pain generators (neuroma, bursitis/seroma/hematoma, scar-related pathology/abscess, foreign bodies), allows Doppler assessment of perfusion and venous thrombosis plus dynamic “sonopalpation” and guidance of minimally invasive interventions, and does so without ionizing radiation – making US the optimal first-line test in the diagnostic workup of RLP. The objective: to identify sonographic diagnostic patterns associated with RLP and evaluate their correlation with clinical presentation. Materials and methods. A prospective observational study included 237 patients following amputation (6–24 months post-amputation) with painful stumps. Clinical evaluation and standardized US were performed using high-frequency linear transducers (10–18 MHz). Sonographic features of neuromas, HO, infection/osteomyelitis, scar contracture, and prosthesis-related complications were documented. Frequencies and clinical correlations were analyzed. Results. Neuromas were detected in 18% of cases, typically as hypoechoic oval lesions continuous with a transected nerve, reproducing pain with probe pressure (Tinel sign). HO was present in 13%, visualized as hyperechoic masses with acoustic shadowing. Infection/abscesses occurred in 12%, appearing as hypoechoic fluid collections with peripheral hypervascularity on Doppler. Scar tethering was identified in 22%, with reduced tissue glide and hyperechoic fibrotic bands. Prosthesis-related complications (bursitis, hematomas, soft tissue edema) were observed in 18%. Clinical correlation confirmed high concordance between ultrasound findings and pain localization. Conclusions. Ultrasound reliably identifies structural causes of RLP, with characteristic patterns for neuromas, HO, infection, and soft tissue pathology. Given its accessibility and dynamic assessment capabilities, US should be considered a first-line imaging modality for evaluating painful amputation stumps.