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Catalog
2023 Workshop Handout Bundle
Basic US of the Upper Limb Nerves- Median and Ulna ...
Basic US of the Upper Limb Nerves- Median and Ulnar from Elbow to Wrist
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Pdf Summary
At the 2023 AANEM Annual Meeting, Dr. Elena Shanina's workshop addressed the essentials of using ultrasound (US) to evaluate the median and ulnar nerves from the elbow to the wrist. The objectives included understanding ultrasound imaging principles, demonstrating scanning techniques, and discussing findings in nerve entrapment neuropathies. High-resolution ultrasonography has become a preferred method over MRI for peripheral nerve assessments due to its higher sensitivity (93% vs. 67%) and several practical advantages, such as being cost-effective, faster, and safer for patients with MRI contraindications.<br /><br />The success of ultrasound in nerve assessments depends significantly on the operator's skill, requiring appropriate training in scanning techniques, image optimization, and interpretation. Key equipment includes a high-frequency linear array transducer, generally with a range of 6-18 MHz for upper limb nerves, and sometimes a small footprint probe for navigating around boney structures.<br /><br />Optimizing ultrasound imaging involves adjusting settings like gain, focus, depth, and frequency, with knowledge of these controls being crucial for achieving the best image quality. Definitions of common ultrasound terminologies (e.g., anechoic, hyperechoic, acoustic shadowing) and techniques modulate brightness and color to visualize structures better.<br /><br />For scanning nerves, identifying anatomic landmarks and using standardized patterns help ensure consistent and accurate evaluations. Normal peripheral nerves exhibit a “honeycomb appearance” on US, with distinct groups of hypoechoic fascicules surrounded by a hyperechoic perineurium. Any deviations in nerve echogenicity or cross-sectional area (CSA) often indicate pathology.<br /><br />Conditions like carpal tunnel syndrome (CTS) and ulnar neuropathy show specific sonographic appearances. CTS is identified by a median nerve CSA of ≥10 mm² and a wrist-forearm CSA ratio of ≥1.4. Ulnar neuropathy commonly presents enlarged nerves at the cubital tunnel. Ultrasound is valuable for differentiating and localizing nerve issues, particularly where electrodiagnostic tests are inconclusive.<br /><br />In summary, ultrasound is a crucial tool for evaluating peripheral nerves, complementing electrodiagnostic tests by providing detailed anatomic information. Its expanding clinical application enhances diagnostic accuracy and patient management in neuromuscular assessments.
Keywords
ultrasound
nmus
sono
US
median nerve
ulnar nerve
nerve entrapment
high-resolution ultrasonography
scanning techniques
image optimization
carpal tunnel syndrome
CTS
ulnar neuropathy
peripheral nerve assessment
CTS
carpal tunnel syndrome
ultrasound
ultrasound
nmus
sono
US
ultrasound
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