Clinical examination and NCS remain the actual gold standard for the evaluation of the peripheral nerve system and are indispensable. a timely start of available treatment and also facilitate follow up of therapy success. for peripheral sensorimotor nerves, UPS for origins C5 and 6 and vagus nerve and UPS for sensory nerves. Additionally, it includes further evaluation of homogeneity of nerve enlargement [87]. With this score, a maximum of 22 points can be reached, resembling significant nerve enlargement in all nerve segments with homogeneous distribution, as for example found in CMT1A. On the other hand, an enlarged UPSB score next to normal UPSA and UPSC scores hints to the analysis of GBS in a typical clinical context or any additional pure radiculitis. An overall score lower than three points excludes swelling or heredity of neuropathy with a negative predictive value of more than 90%. A UPS A score larger than three points without root enlargement (UPS B) suggests the analysis of vasculitis. Additional evaluation of homogeneity of the nerves (median, ulnar and tibial nerve) enables differentiation of CMT1 and CIDP [87]. Next to the UPSS or BUS, Padua et al. explained several echointensity classes in immune-mediated neuropathies [11], which proved its strength inside a prospective study of Haertig et al. [12]. Further, regional or differential fascicle enlargement might be a hallmark in MMN or LSS [8,9]. Thus, a combination of nerve enlargement quantification, fascicle evaluation, echointensity classification and entrapment analysis might contribute to a better variation of neuropathies. However, multicenter evaluation is still required concerning all described rating tools. A summary of BUS and UPSS is definitely demonstrated in Number 5. Noteworthy for XAV 939 these scores is definitely their character as additive tools. These scoring tools must be interpreted in the context of nerve conduction, medical findings and medical history. A UPSS Score of zero points does not exclude immune-mediated forms, for example GBS. However, the accuracy of the Zaidman classification, the UPSS and the BUS was rather superb inside a retrospective meta-analysis so far [149]. 13. Practical Approach Combining Electrophysiology and Nerve Ultrasound Although many aspects concerning the value of nerve ultrasound are still missing in the analysis of PNP, its use for a number of neuropathies has been widely verified. It might help to reduce the high number of unfamiliar etiologies and thus support practitioners to target their diagnostic methods. Still, before carrying out ultrasound, profound knowledge of ultrasound technique, anatomy of the musculoskeletal and nervous system as well as its unique pathologies is essential [6,7]. Thus, hSNFS specialists recommend international trainings and recommendations to learn and to perform ultrasound with common protocols [154,155]. Distinct ultrasound products and probes might hamper this operationalization; however, this hurdle was already taken by additional disciplines, too. However, the authors propose the additive use of ultrasound, particularly in unclear instances of suggested swelling. Further, its use like a biomarker for restorative response might be appropriate in daily routine. Ultrasound is definitely fast and cost-effective and thus could become widely used in contrast to additional imaging tools [156]. Finally, we recommend an algorithm for how to handle ultrasound as an additive XAV 939 tool in the context of clinical exam and nerve conduction studies concerning the most important PNP variants and mimics (Number 6). Open in a separate window Number 6 Proposed diagnostic algorithm and possible, most common differential analysis for clinical routine including clinical exam, nerve conduction studies and nerve ultrasound. * an additional XAV 939 inflammatory component might play a role in nerve enlargement. Abbreviations: ChTx.