Skip to main content

Advertisement

SpringerLink
Log in

Sonographic evaluation of uncommonly assessed upper extremity peripheral nerves: anatomy, technique, and clinical syndromes

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

A Correction to this article was published on 30 July 2018

This article has been updated

Abstract

Targeted ultrasound of the median, ulnar, and radial nerves is a well-established technique for suspected upper extremity peripheral neuropathy. However, sonographic imaging of the brachial plexus and smaller peripheral nerve branches is more technically difficult and the anatomy is less familiar to many radiologists. As imaging techniques improve, many clinicians refer patients for imaging of previously less-familiar structures. In addition, some patients may present with injuries that could involve local neurovascular structures. Finally, patients presenting with isolated peripheral neuropathies may be referred for perineural injections with local anesthetic for diagnostic purposes, or steroid for therapeutic reasons. This requires sonologists to have a firm understanding of the courses of these nerves and the surrounding anatomic landmarks that can be used to accurately identify and characterize them. We discuss clinical syndromes referable to specific peripheral nerve branches in the upper extremity, the relevant anatomy, and sonographic technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

Change history

  • 30 July 2018

    The original version of this article unfortunately contained mistake. Fig. 13a (Anatomy of the Ulnar Digital nerve of the Thumb) as originally published erroneously depicts the ulnar digital nerve of the thumb as a branch of the ulnar nerve.

References

  1. Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology. 2009;250(1):171–7.

    Article  PubMed  Google Scholar 

  2. Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi LE. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics. 2000;20:S199–213.

    Article  PubMed  Google Scholar 

  3. Brown JM, Yablon CM, Morag Y, Brandon CJ, Jacobson JA. US of the peripheral nerves of the upper extremity: a landmark approach. Radiographics. 2016;36(2):452–63.

    Article  PubMed  Google Scholar 

  4. Yablon CM, Hammer MR, Morag Y, Brandon CJ, Fessell DP, Jacobson JA. US of the peripheral nerves of the lower extremity: a landmark approach. Radiographics. 2016;36(2):464–78.

    Article  PubMed  Google Scholar 

  5. Tagliafico A, Martinoli C. Reliability of side-to-side sonographic cross-sectional area measurements of upper extremity nerves in healthy volunteers. J Ultrasound Med. 2013;32:457–62.

    Article  PubMed  Google Scholar 

  6. Neal JM, Gerancher JC, Hebl JR, Ilfeld BM, McCartney CJ, Franco CD. Upper extremity regional anesthesia. Reg Anesth Pain Med. 2009;34(2):134–70.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sehmbi H, Madjdpour C, Shah UJ, Chin KJ. Ultrasound-guided distal peripheral nerve block of the upper limb: a technical review. J Anasethesiol Clin Pharmacol. 2015;31(3):296–307.

    Article  CAS  Google Scholar 

  8. Capek A, Dolan J. Ultrasound-guided peripheral nerve blocks of the upper limb. Continuing education in anaesthesia. Critical care & Pain. 2015;15:160–5.

    Google Scholar 

  9. Nwawka OK, Miller TT. Ultrasound-guided peripheral nerve injection techniques. AJR Am J Roentgenol. 2016;207(3):507–16.

    Article  PubMed  Google Scholar 

  10. Walter RW, Burke CJ, Adler RS. Ultrasound-guided therapeutic injections for neural pathology about the foot and ankle: a 4 year retrospective review. Skelet Radiol. 2017;46(6):795–803.

    Article  Google Scholar 

  11. Orebaugh SL, Williams BA. Brachial plexus anatomy: normal and variant. Sci World J. 2009;9:300–12.

    Article  Google Scholar 

  12. Uysal II, Seker M, Karabulut AK, Buyukmumcu M, Ziylan T. Brachial plexus variations in human fetuses. Neurosurg. 2003;53(3):676–84.

    Article  Google Scholar 

  13. Emamhadi M, Chabok SY, Samini F, Alijani B, Behzadnia H, et al. Anatomical variations of brachial plexus in adult cadavers; a descriptive study. Arch Bone Jt Surg. 2016;4(3):253–8.

    PubMed  PubMed Central  Google Scholar 

  14. Khadilkar SV, Khade SS. Brachial plexopathy. Ann Indian Acad Neurol. 2013;16:12–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lapegue F, Faruch-Bilfeld M, Demondion X, Apredoaei C, Bayol MA, Artico H, et al. Ultrasonography of the brachial plexus, normal appearance and practical applications. Diagn Interv Imaging. 2014;95:259–75.

    Article  CAS  PubMed  Google Scholar 

  16. Canella C, Demondion X, Abreu E, et al. Anatomical study of spinal accessory nerve using ultrasonography. Eur J Radiol. 2013;82(1):56–61.

    Article  PubMed  Google Scholar 

  17. Kennedy E, Albert M, Nicholson H. The fascicular anatomy and peak force capabilities of the sternocleidomastoid muscle. Surg Radiol Anat. 2017;39(6):629–45.

    Article  PubMed  Google Scholar 

  18. Kelley MJ, Kane TE, Leggin BG. Spinal accessory nerve palsy: associated signs and symptoms. J Orthop Sports Phys Ther. 2008;38:78–86.

    Article  PubMed  Google Scholar 

  19. Kakkar C, Shetty CM, Koteshwara P, Baijpai S. Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging. Indian J Radiol Imaging. 2015;25(4):453–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Linda DD, Harish S, Stewart BG, Finlay K, Parusa N, Rebello RP. Multimodality imaging of the peripheral neuropathies of the upper limb and brachial plexus. Radiographics. 2010;30(5):1373–400.

    Article  PubMed  Google Scholar 

  21. Stephens L, Kinderknecht JJ, Wen DY. Musculocutaneous nerve injury in a high school pitcher. Clin J Sport Med. 2014;24(6):e68–9.

    Article  PubMed  Google Scholar 

  22. Chiavaras MM, Jacobson JA, Billone L, Lawton JM, Lawton J. Sonography of the lateral antebrachial cutaneous nerve with magnetic resonance imaging with anatomic correlation. J Ultrasound Med. 2014;33(8):1475–83.

    Article  PubMed  Google Scholar 

  23. Miller TT, Reinus WR. Nerve entrapment syndromes of the elbow, forearm, and wrist. AJR Am J Roentgenol. 2010;195:585–94.

    Article  PubMed  Google Scholar 

  24. Lee MJ, LaStayo PC. Pronator syndrome and other nerve compressions that mimic carpal tunnel syndrome. J Orthop Sports Phys Ther. 2004;34(10):601–9.

    Article  PubMed  Google Scholar 

  25. Strakowski JA. Ultrasound-guided peripheral nerve procedures. Phys Med Rehabil Clin N Am. 2016 Aug;27(3):687–715.

    Article  PubMed  Google Scholar 

  26. Sehmbi H, Madjdpour C, Shah UJ, Chin KJ. Ultrasound-guided distal peripheral nerve block of the upper limb: a technical review. J Anaesthesiol Clin Pharmacol. 2015;31(3):296–307.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hide IG, Grainger AJ, Naisby GP, Campbell RS. Sonographic findings in anterior interosseous nerve syndrome. J Clin Ultrasound. 1999;27:459–64.

    Article  CAS  PubMed  Google Scholar 

  28. Cheung JW, Shyu JF, Teng CC, Chen TH, Su CH, et al. The anatomical variations of the palmar cutaneous branch of the median nerve in Chinese adults. J Chin Med Assoc. 2004;67(1):27–31.

    PubMed  Google Scholar 

  29. Nagle DJ, Santiago KJ. Anomalous palmar cutaneous branch of the median nerve in the distal forearm: a case report. Hand Surg Am. 2008;33(8):1329–30.

    Article  Google Scholar 

  30. Tagliafico A, Pugliese F, Bianchi S, Bodner G, Padua L, Rubino M, et al. High-resolution sonography of the palmar cutaneous branch of the median nerve. AJR Am J Roentgenol. 2008;191(1):107–14.

    Article  PubMed  Google Scholar 

  31. Riegler G, Pivec C, Platzgummer H, Lieba-Samal D, Brugger P, Jengojan S, et al. High-resolution ultrasound visualization of the recurrent motor branch of the median nerve: normal and first pathological findings. Eur J Radiol. 2017;27(7):2941–9.

    Article  Google Scholar 

  32. Shams OE, Al-Ghanmdi SM. Isolated neuropathy of recurrent motor branch of median nerve. Neurosciences (Riyadh). 2006;11:326–8.

    Google Scholar 

  33. Duggal A, Anastakis DJ, Salonen D, Becker E. Compression of the deep palmar branch of the ulnar nerve by a ganglion. Hand. 2006;1:98–101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kim SS, Kim JH, Kand HI, Lee SJ. Ulnar nerve compression at Guyon’s canal by an arteriovenous malformation. J Korean Neurosurg Soc. 2009;45:57–9.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Le Corroller T, Bauones S, Acid S, Champsaur P. Anatomical study of the dorsal cutaneous branch of the ulnar nerve using ultrasound. Eur J Radiol. 2013;23:2246–51.

    Article  Google Scholar 

  36. Wajid H, LeBlanc J, Shapiro DB, Delzell PB. Bowler’s thumb: ultrasound diagnosis of a neuroma of the ulnar digital nerve of the thumb. Skelet Radiol. 2016;45:1589–92.

    Article  Google Scholar 

  37. Meng S, Tinhofer I, Weninger WJ, Grisold W. Anatomical and ultrasound correlation of the superficial branch of the radial nerve. Muscle Nerve. 2014;50(6):939–42.

    Article  PubMed  Google Scholar 

  38. Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 2006;26(5):1267–87.

    Article  PubMed  Google Scholar 

  39. Choi S-J, Ahn JH, Ryu DS, Kang CH, Jung SM, Park MS. Ultrasonography for nerve compression syndromes of the upper extremity. Ultrasonography. 2015;34(4):275–91.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Chien AJ, Jamadar DA, Jacobson JA, Hayes CW, Louis D. Sonography and MR imaging of posterior interosseous nerve syndrome with surgical correlation. AJR Am J Roentgenol. 2003;181:219–21.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair St. Ste 800, Chicago, IL, 60616, USA

    Jonathan M. Youngner, Kulia Matsuo, Tom Grant, Ankur Garg, Jonathan Samet & Imran M. Omar

  2. Department of Radiology, Lurie Children’s Hospital, Chicago, IL, USA

    Jonathan Samet

Authors
  1. Jonathan M. Youngner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kulia Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tom Grant
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ankur Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jonathan Samet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Imran M. Omar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan M. Youngner.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Youngner, J.M., Matsuo, K., Grant, T. et al. Sonographic evaluation of uncommonly assessed upper extremity peripheral nerves: anatomy, technique, and clinical syndromes. Skeletal Radiol 48, 57–74 (2019). https://doi.org/10.1007/s00256-018-3028-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-018-3028-z

Keywords

Search

Navigation