Ultrasonography of the Peripheral Nerves of the Forearm, Wrist and Hand: Definition of Landmarks, Anatomical Correlation and Clinical Implications

Abstract

Background Peripheral nerve pathologies of the upper extremity are increasingly assessed by high-resolution ultrasonography (HRUS), yet rapid identification of nerve segments can be difficult due to small nerve diameters and complex regional anatomy. We propose a landmark-based approach to speed up and facilitate evaluation and intervention in this region.

Method Relevant landmarks and section planes for eleven nerve segments of the forearm, wrist and hand were defined by ultrasonography in cadaver arms before cryosection and topographical neurovascular preparation. Information on all nerve segments and a pictorial guide including anatomical cross-sections, topographical preparations and HRUS images are provided. The identification rates of these nerve segments were then assessed in 20 healthy volunteers.

Results and Conclusion Sonographic landmarks and guidelines for the rapid identification and assessment of nerves of the forearm, wrist and hand are presented in pictorial and tabular form, including discussion of normal variants. Utilizing this overview should facilitate training, diagnostic examinations and intervention for nerves of the upper extremity.

Key Points: 

• High-resolution ultrasound enables assessment of peripheral nerves of the forearm, wrist and hand.

• A landmark-based approach can facilitate and speed up nerve evaluation in these regions.

• High detection rates could be reproduced using the proposed landmark-based approach.

Citation Format

• Gruber L, Loizides A, Peer S et al. Ultrasonography of the Peripheral Nerves of the Forearm, Wrist and Hand: Definition of Landmarks, Anatomical Correlation and Clinical Implications. Fortschr Röntgenstr 2020; 192: 1060 – 1072

Zusammenfassung

Hintergrund Periphere Nervenpathologien an der oberen Extremität werden zunehmend mittels hochauflösenden Ultraschalls (HRUS) untersucht, wobei die zügige Identifikation bestimmter Nervensegmente durch geringe Nervendurchmesser und komplexe regionale Anatomie erschwert sein kann. Landmarken könnten hier die Zeiteffizienz sowie Beurteilbarkeit in der entsprechenden Region verbessern.

Methode Relevante Landmarken und Schnittebenen für 11 Nervensegmente an Unterarm, Handgelenk und Hand wurden an Leichenarmen mittels HRUS definiert. Anschließend wurden korrelierende Gefrierschnitte und topografische neurovaskuläre Präparationen durchgeführt. Dieser Artikel bietet anatomische Schnitte, topografische Erläuterungen sowie hochauflösende sonoanatomische Korrelationen der beschriebenen Nervensegmente. Zudem wurde das erfolgreiche Auffinden der Nervensegmente anhand der Landmarken an 20 gesunden Probanden evaluiert.

Ergebnisse und Schlussfolgerung Sonografische Landmarken und Anleitungen für die rasche Identifikation und Beurteilung von peripheren Nerven von Unterarm, Handgelenk und Hand werden in sonoanatomisch-korrelierender sowie in tabellarischer Form unter Berücksichtigung von Normvarianten präsentiert. Das Erlernen der peripheren Nervensonografie sowie die diagnostische Beurteilung und gegebenenfalls therapeutische Intervention der entsprechenden Nerven sollen anhand dieses Manuskripts erleichtert werden.

Kernaussagen: 

• Hochauflösender Ultraschall ermöglicht die Untersuchung von peripheren Nerven an Unterarm, Handgelenk und Hand.

• Anatomische Landmarken erleichtern und beschleunigen das Auffinden und die Evaluierung dieser Nervenäste.

• Mit der Landmark-basierten Herangehensweise lassen sich hohe Detektionsraten der Nervenäste erzielen.

Key words

ultrasound - anatomy - nervous-peripheral - hand

Publication History

Received: 11 September 2019

Accepted: 27 January 2020

Article published online:
04 March 2020

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