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Semin Musculoskelet Radiol 2022; 26(02): 123-139
DOI: 10.1055/s-0042-1743407
Review Article

Imaging of Nerve Disorders in the Elbow

Drew Gunio
1   Division of Clinical Radiology, Department of Radiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
,
Ahmad Babaa
2   Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Jenny T. Bencardino
2   Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract

Neuropathies of the elbow represent a spectrum of disorders that involve more frequently the ulnar, radial, and median nerves. Reported multiple pathogenic factors include mechanical compression, trauma, inflammatory conditions, infections, as well as tumor-like and neoplastic processes. A thorough understanding of the anatomy of these peripheral nerves is crucial because clinical symptoms and imaging findings depend on which components of the affected nerve are involved. Correlating clinical history with the imaging manifestations of these disorders requires familiarity across all diagnostic modalities. This understanding allows for a targeted imaging work-up that can lead to a prompt and accurate diagnosis.

Keywords

neuropathy - ulnar nerve - radial nerve - median nerve


Publication History

Article published online:
24 May 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013; 80 (18) 1634-1640
    CrossrefPubMedSearch in Google Scholar
  • 2 Silvestri E, Martinoli C, Derchi LE, Bertolotto M, Chiaramondia M, Rosenberg I. Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology 1995; 197 (01) 291-296
    CrossrefPubMedSearch in Google Scholar
  • 3 Stuart RM, Koh ES, Breidahl WH. Sonography of peripheral nerve pathology. AJR Am J Roentgenol 2004; 182 (01) 123-129
    CrossrefPubMedSearch in Google Scholar
  • 4 Ellis JRC, McNally EG, Scott PM. Ultrasound of peripheral nerves. Imaging 2002; 14 (03) 217-222
    CrossrefPubMedSearch in Google Scholar
  • 5 Hörmann M, Traxler H, Ba-Ssalamah A. et al. Correlative high-resolution MR-anatomic study of sciatic, ulnar, and proper palmar digital nerve. Magn Reson Imaging 2003; 21 (08) 879-885
    CrossrefPubMedSearch in Google Scholar
  • 6 Filler AG, Maravilla KR, Tsuruda JS. MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature. Neurol Clin 2004; 22 (03) 643-682 , vi–viivi–vii
    CrossrefPubMedSearch in Google Scholar
  • 7 Filler AG, Kliot M, Howe FA. et al. Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology. J Neurosurg 1996; 85 (02) 299-309
    CrossrefPubMedSearch in Google Scholar
  • 8 Bartels RH, Verbeek AL. Risk factors for ulnar nerve compression at the elbow: a case control study. Acta Neurochir (Wien) 2007; 149 (07) 669-674 ; discussion 674
    CrossrefPubMedSearch in Google Scholar
  • 9 Jensen A, Kaerlev L, Tüchsen F. et al. Locomotor diseases among male long-haul truck drivers and other professional drivers. Int Arch Occup Environ Health 2008; 81 (07) 821-827
    CrossrefPubMedSearch in Google Scholar
  • 10 Darowish M, Lawton JN, Evans PJQ. Q:What is cell phone elbow, and what should we tell our patients?. Cleve Clin J Med 2009; 76 (05) 306-308
    CrossrefPubMedSearch in Google Scholar
  • 11 Cummins CA, Schneider DS. Peripheral nerve injuries in baseball players. Neurol Clin 2008; 26 (01) 195-215 , xx
    CrossrefPubMedSearch in Google Scholar
  • 12 Gellman H. Compression of the ulnar nerve at the elbow: cubital tunnel syndrome. Instr Course Lect 2008; 57: 187-197
    PubMedSearch in Google Scholar
  • 13 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 (Spec No): discussion S213–S217 S199-S213
    CrossrefPubMedSearch in Google Scholar
  • 14 Husarik DB, Saupe N, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Elbow nerves: MR findings in 60 asymptomatic subjects—normal anatomy, variants, and pitfalls. Radiology 2009; 252 (01) 148-156
    CrossrefPubMedSearch in Google Scholar
  • 15 Eng HY, Gunio DA, Benitez CL. Quantitative magnetic resonance imaging analysis of the cross-sectional areas of the anconeus epitrochlearis muscle, cubital tunnel, and ulnar nerve with the elbow in extension in patients with and without ulnar neuropathy. J Shoulder Elbow Surg 2018; 27 (07) 1306-1310
    CrossrefPubMedSearch in Google Scholar
  • 16 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 (01) 85-89
    CrossrefPubMedSearch in Google Scholar
  • 17 Tsai P, Steinberg DR. Median and radial nerve compression about the elbow. Instr Course Lect 2008; 57: 177-185
    PubMedSearch in Google Scholar
  • 18 Clavert P, Lutz JC, Adam P, Wolfram-Gabel R, Liverneaux P, Kahn JL. Frohse's arcade is not the exclusive compression site of the radial nerve in its tunnel. Orthop Traumatol Surg Res 2009; 95 (02) 114-118
    CrossrefPubMedSearch in Google Scholar
  • 19 Rosenbaum R. Disputed radial tunnel syndrome. Muscle Nerve 1999; 22 (07) 960-967
    CrossrefPubMedSearch in Google Scholar
  • 20 Bodner G, Harpf C, Meirer R, Gardetto A, Kovacs P, Gruber H. Ultrasonographic appearance of supinator syndrome. J Ultrasound Med 2002; 21 (11) 1289-1293
    CrossrefPubMedSearch in Google Scholar
  • 21 Ferdinand BD, Rosenberg ZS, Schweitzer ME. et al. MR imaging features of radial tunnel syndrome: initial experience. Radiology 2006; 240 (01) 161-168
    CrossrefPubMedSearch in Google Scholar
  • 22 Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part I: radial nerve. J Hand Surg Am 2009; 34 (10) 1906-1914
    CrossrefPubMedSearch in Google Scholar
  • 23 Berger RA. Hand Surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2004
    Search in Google Scholar
  • 24 al-Qattan MM. Gantzer's muscle. An anatomical study of the accessory head of the flexor pollicis longus muscle. J Hand Surg [Br] 1996; 21 (02) 269-270
    CrossrefPubMedSearch in Google Scholar
  • 25 Mahakkanukrauh P, Surin P, Ongkana N, Sethadavit M, Vaidhayakarn P. Prevalence of accessory head of flexor pollicis longus muscle and its relation to anterior interosseous nerve in Thai population. Clin Anat 2004; 17 (08) 631-635
    CrossrefPubMedSearch in Google Scholar
  • 26 Nakano KK. Nerve entrapment syndromes. Curr Opin Rheumatol 1997; 9 (02) 165-173
    CrossrefPubMedSearch in Google Scholar
  • 27 Kim S, Choi JY, Huh YM. 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 1. Overview and lower extremity. Eur Radiol 2007; 17 (01) 139-149
    CrossrefPubMedSearch in Google Scholar
  • 28 Dunn AJ, Salonen DC, Anastakis DJ. MR imaging findings of anterior interosseous nerve lesions. Skeletal Radiol 2007; 36 (12) 1155-1162
    CrossrefPubMedSearch in Google Scholar
  • 29 Hide IG, Grainger AJ, Naisby GP, Campbell RS. Sonographic findings in the anterior interosseous nerve syndrome. J Clin Ultrasound 1999; 27 (08) 459-464
    CrossrefPubMedSearch in Google Scholar
  • 30 Gyftopoulos S, Rosenberg ZS, Petchprapa C. Increased MR signal intensity in the pronator quadratus muscle: Does it always indicate anterior interosseous neuropathy?. AJR Am J Roentgenol 2010; 194 (02) 490-493
    CrossrefPubMedSearch in Google Scholar
  • 31 Johnson RK, Spinner M, Shrewsbury MM. Median nerve entrapment syndrome in the proximal forearm. J Hand Surg Am 1979; 4 (01) 48-51
    CrossrefPubMedSearch in Google Scholar
  • 32 Lee MJ, LaStayo PC. Pronator syndrome and other nerve compressions that mimic carpal tunnel syndrome. J Orthop Sports Phys Ther 2004; 34 (10) 601-609
    CrossrefPubMedSearch in Google Scholar
  • 33 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 (05) 1267-1287
    CrossrefPubMedSearch in Google Scholar
  • 34 Chung C. Miscellaneous disorders of the elbow. In: Chung C, Steinbach L. eds. MRI of the Upper Extremity: Shoulder, Elbow, Wrist and Hand. Philadelphia, PA: Lippincott Williams & Wilkins; 2010: 491-525
    Search in Google Scholar
  • 35 Nebot-Cegarra J, Reina-de la Torre F, Pérez-Berruezo J. Accessory fasciculi of the human pronator teres muscle: incidence, morphological characteristics and relation to the median nerve. Ann Anat 1994; 176 (03) 223-227
    CrossrefPubMedSearch in Google Scholar
  • 36 Bezerra AJ, Carvalho VC, Nucci A. An anatomical study of the palmar cutaneous branch of the median nerve. Surg Radiol Anat 1986; 8 (03) 183-188
    CrossrefPubMedSearch in Google Scholar
  • 37 Rodriguez-Niedenführ M, Vazquez T, Parkin I, Logan B, Sañudo JR. Martin-Gruber anastomosis revisited. Clin Anat 2002; 15 (02) 129-134
    CrossrefPubMedSearch in Google Scholar
  • 38 Mathew D, Wong M. The efficacy of the ultrasound guided ICB nerve block and brachial plexus nerve block for upper arm transposed brachial-basilic arteriovenous fistula in vascular access surgeries. Reg Anesth Pain Med 2021; 70: A78-A79
    PubMedSearch in Google Scholar
  • 39 Caetano EB, Sabongi NetoJJ, Vieira LA, Caetano MF, de Bona JE, Simonatto TM. Struthers' ligament and supracondylar humeral process: an anatomical study and clinical implications. Acta Ortop Bras 2017; 25 (04) 137-142
    CrossrefPubMedSearch in Google Scholar
  • 40 Seddon HJ. A classification of nerve injuries. BMJ 1942; 2 (4260): 237-239
    CrossrefPubMedSearch in Google Scholar
  • 41 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74 (04) 491-516
    CrossrefPubMedSearch in Google Scholar
  • 42 Netscher D, Murphy K, Fiore NA. Chapter 70: Hand surgery. Nerve compression syndrome. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. eds. Sabiston Textbook of Surgery. 19th ed.. Philadelphia, PA: Elsevier; 2012: 1982-1984
    Search in Google Scholar
  • 43 Negrin P, Fardin P. “Sleep paralysis” of the radial nerve: clinical and electromyographical evolution of 10 cases. Electromyogr Clin Neurophysiol 1979; 19 (05) 435-441
    PubMedSearch in Google Scholar
  • 44 Kouyoumdjian JA, Graça CR, Ferreira VFM. Peripheral nerve injuries: a retrospective survey of 1124 cases. Neurol India 2017; 65 (03) 551-555
    CrossrefPubMedSearch in Google Scholar
  • 45 Upadhyaya V, Upadhyaya DN, Mishra B. MR neurography in traumatic, non-obstetric paediatric brachial plexopathy. Eur Radiol 2018; 28 (06) 2417-2424
    CrossrefPubMedSearch in Google Scholar
  • 46 Menorca RM, Fussell TS, Elfar JC. Nerve physiology: mechanisms of injury and recovery. Hand Clin 2013; 29 (03) 317-330
    CrossrefPubMedSearch in Google Scholar
  • 47 Mondelli M, Morana P, Ballerini M, Rossi S, Giannini F. Mononeuropathies of the radial nerve: clinical and neurographic findings in 91 consecutive cases. J Electromyogr Kinesiol 2005; 15 (04) 377-383
    CrossrefPubMedSearch in Google Scholar
  • 48 Agarwal A, Chandra A, Jaipal U, Saini N. Imaging in the diagnosis of ulnar nerve pathologies—a neoteric approach. Insights Imaging 2019; 10 (01) 37
    CrossrefPubMedSearch in Google Scholar
  • 49 Ferlic DC, Ries MD. Epineural ganglion of the ulnar nerve at the elbow. J Hand Surg Am 1990; 15 (06) 996-998
    CrossrefPubMedSearch in Google Scholar
  • 50 Thiyam R, Lalchandani R. Tardy ulnar nerve palsy after fracture non-union medial epicondyle of humerus—an unusual case. J Clin Orthop Trauma 2015; 6 (02) 137-139
    CrossrefPubMedSearch in Google Scholar
  • 51 Gstoettner C, Mayer JA, Rassam S. et al. Neuralgic amyotrophy: a paradigm shift in diagnosis and treatment. J Neurol Neurosurg Psychiatry 2020; 91 (08) 879-888
    CrossrefPubMedSearch in Google Scholar
  • 52 van Rosmalen M, Lieba-Samal D, Pillen S, van Alfen N. Ultrasound of peripheral nerves in neuralgic amyotrophy. Muscle Nerve 2019; 59 (01) 55-59
    CrossrefPubMedSearch in Google Scholar
  • 53 Scalf RE, Wenger DE, Frick MA, Mandrekar JN, Adkins MC. MRI findings of 26 patients with Parsonage-Turner syndrome. AJR Am J Roentgenol 2007; 189 (01) W39-44
    CrossrefPubMedSearch in Google Scholar
  • 54 Décard BF, Pham M, Grimm A. Ultrasound and MRI of nerves for monitoring disease activity and treatment effects in chronic dysimmune neuropathies. Current concepts and future directions. Clin Neurophysiol 2018; 129 (01) 155-167
    CrossrefPubMedSearch in Google Scholar
  • 55 Carandang MAE, Takamatsu N, Nodera H. et al. Velocity of intraneural blood flow is increased in inflammatory neuropathies: sonographic observation. J Neurol Neurosurg Psychiatry 2017; 88 (05) 455-457
    CrossrefPubMedSearch in Google Scholar
  • 56 Neubauer C, Gruber H, Bäuerle J, Egger K. Ultrasonography of multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). Clin Neuroradiol 2015; 25 (04) 423-425
    CrossrefPubMedSearch in Google Scholar
  • 57 Herraets IJT, Goedee HS, Telleman JA. et al. Nerve ultrasound for diagnosing chronic inflammatory neuropathy: a multicenter validation study. Neurology 2020; 95 (12) e1745-e1753
    CrossrefPubMedSearch in Google Scholar
  • 58 Beekman R, van den Berg LH, Franssen H, Visser LH, van Asseldonk JT, Wokke JH. Ultrasonography shows extensive nerve enlargements in multifocal motor neuropathy. Neurology 2005; 65 (02) 305-307
    CrossrefPubMedSearch in Google Scholar
  • 59 Merola A, Rosso M, Romagnolo A, Peci E, Cocito D. Peripheral nerve ultrasonography in chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy: correlations with clinical and neurophysiological data. Neurol Res Int 2016; 2016: 9478593
    CrossrefPubMedSearch in Google Scholar
  • 60 Sindic CJ. Infectious neuropathies. Curr Opin Neurol 2013; 26 (05) 510-515
    CrossrefPubMedSearch in Google Scholar
  • 61 Lindland ES, Solheim AM, Andreassen S. et al. Imaging in Lyme neuroborreliosis. Insights Imaging 2018; 9 (05) 833-844
    CrossrefPubMedSearch in Google Scholar
  • 62 Jabeen S, Saini J, Vengalil S. et al. Neuroimaging in leprosy: the nerves and beyond. Radiol Infect Dis 2020; 7: 12-21
    CrossrefPubMedSearch in Google Scholar
  • 63 Fernandez CE, Franz CK, Ko JH. et al. Imaging review of peripheral nerve injuries in patients with COVID-19. Radiology 2021; 298 (03) E117-E130
    CrossrefPubMedSearch in Google Scholar
  • 64 Kransdorf MJ, Murphey II MD. eds. Imaging of Soft Tissue Tumors. Philadelphia, PA: Lippincott Williams & Wilkins; 2006: 329-380
    Search in Google Scholar
  • 65 Lin J, Martel W. Cross-sectional imaging of peripheral nerve sheath tumors: characteristic signs on CT, MR imaging, and sonography. AJR Am J Roentgenol 2001; 176 (01) 75-82
    CrossrefPubMedSearch in Google Scholar
  • 66 Chee DW, Peh WC, Shek TW. Pictorial essay: imaging of peripheral nerve sheath tumours. Can Assoc Radiol J 2011; 62 (03) 176-182
    CrossrefPubMedSearch in Google Scholar
  • 67 Jee WH, Oh SN, McCauley T. et al. Extraaxial neurofibromas versus neurilemmomas: discrimination with MRI. AJR Am J Roentgenol 2004; 183 (03) 629-633
    CrossrefPubMedSearch in Google Scholar
  • 68 Banks KP. The target sign: extremity. Radiology 2005; 234 (03) 899-900
    CrossrefPubMedSearch in Google Scholar
  • 69 Slam KD, Bohman SL, Sharma R, Chaudhuri PK. Surgical considerations for the familial cancer syndrome, neurofibromatosis 1: a comprehensive review. Am Surg 2009; 75 (02) 120-128
    CrossrefPubMedSearch in Google Scholar
  • 70 Isobe K, Shimizu T, Akahane T, Kato H. Imaging of ancient schwannoma. AJR Am J Roentgenol 2004; 183 (02) 331-336
    CrossrefPubMedSearch in Google Scholar
  • 71 Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics 1999; 19 (05) 1253-1280
    CrossrefPubMedSearch in Google Scholar
  • 72 Khurana A, Novo M, Nowakowski GS. et al. Clinical manifestations of, diagnostic approach to, and treatment of neurolymphomatosis in the rituximab era. Blood Adv 2021; 5 (05) 1379-1387
    CrossrefPubMedSearch in Google Scholar