ABSTRACT
Several entrapment neuropathies of the upper extremity can cause hypoechoic swelling and nerve compression as seen at ultrasound. The ulnar nerve can be compressed at the cubital tunnel of the elbow and Guyon's canal at the wrist. The deep branch of the radial nerve can be compressed at the supinator muscle at the elbow, and the superficial radial nerve may be compressed at the dorsal wrist (Wartenberg's syndrome). In addition to compression at the carpal tunnel, the median nerve may be compressed at the elbow, related to a supracondylar process or by the pronator teres. Knowledge of these key anatomical sites of potential nerve compression is essential for accurate diagnosis of entrapment neuropathies.
KEYWORDS
Nerve - ultrasound - entrapment - neuropathy - extremity
REFERENCES
-
1
Mayer V.
Ultrasonography of the rotator cuff.
J Ultrasound Med.
1985;
4(11)
608, 607
-
2
Erickson S J.
High-resolution imaging of the musculoskeletal system.
Radiology.
1997;
205(3)
593-618
-
3
Silvestri E, Martinoli C, Derchi L E, Bertolotto M, Chiaramondia M, Rosenberg I.
Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons.
Radiology.
1995;
197(1)
291-296
-
4
Stewart J D.
Peripheral nerve fascicles: anatomy and clinical relevance.
Muscle Nerve.
2003;
28(5)
525-541
-
5
Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi L E.
US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs.
Radiographics.
2000;
20(Spec No)
S199-S213; discussion S213–S217
-
6
Andreisek G, Crook D W, Burg D, Marincek B, Weishaupt D.
Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features.
Radiographics.
2006;
26(5)
1267-1287
-
7
Kim S, Choi J Y, Huh Y M et al..
Role of magnetic resonance imaging in entrapment and compressive neuropathy—what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity.
Eur Radiol.
2007;
17(2)
509-522
-
8
Powell H C, Myers R R.
Pathology of experimental nerve compression.
Lab Invest.
1986;
55(1)
91-100
-
9
Martinoli C, Bianchi S, Pugliese F et al..
Sonography of entrapment neuropathies in the upper limb (wrist excluded).
J Clin Ultrasound.
2004;
32(9)
438-450
-
10
Contreras M G, Warner M A, Charboneau W J, Cahill D R.
Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences.
Clin Anat.
1998;
11(6)
372-378
-
11
Beekman R, Schoemaker M C, Van Der Plas J P et al..
Diagnostic value of high-resolution sonography in ulnar neuropathy at the elbow.
Neurology.
2004;
62(5)
767-773
-
12
Chiou H J, Chou Y H, Cheng S P et al..
Cubital tunnel syndrome: diagnosis by high-resolution ultrasonography.
J Ultrasound Med.
1998;
17(10)
643-648
-
13
Husarik D B, Saupe N, Pfirrmann C W, Jost B, Hodler J, Zanetti M.
Elbow nerves: MR findings in 60 asymptomatic subjects—normal anatomy, variants, and pitfalls.
Radiology.
2009;
252(1)
148-156
-
14
Yoon J S, Walker F O, Cartwright M S.
Ultrasonographic swelling ratio in the diagnosis of ulnar neuropathy at the elbow.
Muscle Nerve.
2008;
38(4)
1231-1235
-
15
Okamoto M, Abe M, Shirai H, Ueda N.
Diagnostic ultrasonography of the ulnar nerve in cubital tunnel syndrome.
J Hand Surg [Br].
2000;
25(5)
499-502
-
16
O'Driscoll S W, Horii E, Carmichael S W, Morrey B F.
The cubital tunnel and ulnar neuropathy.
J Bone Joint Surg Br.
1991;
73(4)
613-617
-
17
Okamoto M, Abe M, Shirai H, Ueda N.
Morphology and dynamics of the ulnar nerve in the cubital tunnel. Observation by ultrasonography.
J Hand Surg [Br].
2000;
25(1)
85-89
-
18
Jacobson J A, Jebson P J, Jeffers A W, Fessell D P, Hayes C W.
Ulnar nerve dislocation and snapping triceps syndrome: diagnosis with dynamic sonography—report of three cases.
Radiology.
2001;
220(3)
601-605
-
19
Velling T E, Brennan F J, Hall L D, Puckett M L, Reeves T R, Powell C C.
Sonographic diagnosis of ulnar artery aneurysm in hypothenar hammer syndrome: report of 2 cases.
J Ultrasound Med.
2001;
20(8)
921-924
-
20
Inaparthy P K, Anwar F, Botchu R, Jähnich H, Katchburian M V.
Compression of the deep branch of the ulnar nerve in Guyon's canal by a ganglion: two cases.
Arch Orthop Trauma Surg.
2008;
128(7)
641-643
-
21
Sakai K, Tsutsui T, Aoi M, Sonobe H, Murakami H.
Ulnar neuropathy caused by a lipoma in Guyon's canal—case report.
Neurol Med Chir (Tokyo).
2000;
40(6)
335-338
-
22
Harvie P, Patel N, Ostlere S J.
Ulnar nerve compression at Guyon's canal by an anomalous abductor digiti minimi muscle: the role of ultrasound in clinical diagnosis.
Hand Surg.
2003;
8(2)
271-275
-
23
Timins M E.
Muscular anatomic variants of the wrist and hand: findings on MR imaging.
AJR Am J Roentgenol.
1999;
172(5)
1397-1401
-
24
Bodner G, Buchberger W, Schocke M et al..
Radial nerve palsy associated with humeral shaft fracture: evaluation with US—initial experience.
Radiology.
2001;
219(3)
811-816
-
25
Bodner G, Schocke M F, Rachbauer F et al..
Differentiation of malignant and benign musculoskeletal tumors: combined color and power Doppler US and spectral wave analysis.
Radiology.
2002;
223(2)
410-416
-
26
Chien A J, Jamadar D A, Jacobson J A, Hayes C W, Louis D S.
Sonography and MR imaging of posterior interosseous nerve syndrome with surgical correlation.
AJR Am J Roentgenol.
2003;
181(1)
219-221
-
27
Kinni V, Craig J, van Holsbeeck M, Ditmars D.
Entrapment of the posterior interosseous nerve at the arcade of Frohse with sonographic, magnetic resonance imaging, and intraoperative confirmation.
J Ultrasound Med.
2009;
28(6)
807-812
-
28
Skaf A Y, Boutin R D, Dantas R W et al..
Bicipitoradial bursitis: MR imaging findings in eight patients and anatomic data from contrast material opacification of bursae followed by routine radiography and MR imaging in cadavers.
Radiology.
1999;
212(1)
111-116
-
29
De Maeseneer M, Marcelis S, Jager T, Girard C, Gest T, Jamadar D.
Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections.
J Ultrasound Med.
2009;
28(6)
779-786
-
30
Natsis K.
Supracondylar process of the humerus: study on 375 Caucasian subjects in Cologne, Germany.
Clin Anat.
2008;
21(2)
138-141
-
31
Valbuena S E, O'Toole G A, Roulot E.
Compression of the median nerve in the proximal forearm by a giant lipoma: a case report.
J Brachial Plex Peripher Nerve Inj.
2008;
3
17
-
32
Hide I G, Grainger A J, Naisby G P, Campbell R S.
Sonographic findings in the anterior interosseous nerve syndrome.
J Clin Ultrasound.
1999;
27(8)
459-464
Jon A JacobsonM.D.
Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan
1500 East Medical Center Dr., TC-2910 L, Ann Arbor, MI 48109-0326
Email: jjacobsn@umich.edu
