2025 Workshop Handout Bundle-W92RFC Advanced Nerve US - upper limb

W92RFC Advanced Nerve US - upper limb - Dutton Meiling

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This workshop on Advanced Nerve Ultrasound (NMUS) for upper limb nerves, led by Drs. Rebecca Dutton and James Meiling, targets residents and fellows with prior ultrasound experience. It emphasizes hands-on scanning techniques of the major nerves of the upper limb, correlating anatomy with common nerve entrapment syndromes.

Key nerves covered include:

1. <strong>Median Nerve:</strong> Runs superficially to the brachial artery in the upper arm, crossing medially at mid-arm. At the elbow, it lies between brachialis and pronator teres, with potential entrapment sites distal to the elbow such as the pronator teres heads and flexor digitorum superficialis arcade. In the forearm, it travels between flexor digitorum superficialis and profundus; the anterior interosseous and palmar cutaneous branches arise here. At the wrist, it passes under the transverse carpal ligament within the carpal tunnel, which includes tendons and the nerve, related to Carpal Tunnel Syndrome.

2. <strong>Ulnar Nerve:</strong> Positioned medial to the axillary artery in the arm, coursing near the triceps. At the elbow, it lies within the retrocondylar groove formed by the medial epicondyle, olecranon, and Osborne’s ligament. Dynamic imaging can detect nerve subluxation. The true cubital tunnel is formed by flexor carpi ulnaris heads. In the forearm, it lies medial to flexor digitorum muscles and near the ulnar artery, giving palmar and dorsal branches. At the wrist, it passes superficially to the carpal ligament in Guyon’s canal, splitting into superficial and deep branches. It is associated with Cubital Tunnel and Ulnar Canal Syndromes.

3. <strong>Radial Nerve:</strong> Runs along the deep brachial artery, closely applied to the humerus in the spiral groove. At the elbow, it divides into superficial (sensory) and deep branches (posterior interosseous nerve). The deep branch pierces the supinator muscle (radial tunnel), relevant to Radial Tunnel Syndrome. The superficial branch lies under brachioradialis, becoming subcutaneous near the wrist, vulnerable to Wartenberg Syndrome.

Other highlighted nerves include the lateral and medial antebrachial cutaneous nerves, with clinical relevance to venipuncture and cubital tunnel surgery. Brachial plexus scanning is demonstrated at supraclavicular, infraclavicular, and axillary levels, focusing on nerve roots, trunks, cords, and branches.

The workshop stresses anatomical landmarks, dynamic assessment, and Doppler imaging to distinguish nerve from vascular structures, enhancing diagnosis of entrapment neuropathies in the upper limb.

Keywords

Advanced Nerve Ultrasound

Upper Limb Nerves

Median Nerve

Ulnar Nerve

Radial Nerve

Nerve Entrapment Syndromes

Carpal Tunnel Syndrome

CTS

Cubital Tunnel Syndrome

Radial Tunnel Syndrome

Brachial Plexus Ultrasound