2026 Workshop Handout Bundle-W293RF - Basic MSK and Nerve US Upper Limb

W293RF - Basic MSK and Nerve US Upper Limb - Dutton Xu

Pdf Summary

This workshop handout introduces basic musculoskeletal and nerve ultrasound of the upper limb. It covers image optimization, probe technique, tissue appearance, and landmarks for examining the median, ulnar, and radial nerves.

<strong>Image optimization:</strong> Transducer frequency balances resolution and penetration: higher frequencies suit superficial structures, while lower frequencies reach deeper tissues. Adjust depth to keep the structure of interest near the center of the image; increasing depth reduces resolution. Gain amplifies returning echoes to compensate for signal loss, the focal zone marks the narrowest part of the beam, and color flow helps identify vessels.

<strong>Technique and tissue appearance:</strong> Hold the transducer between the thumb and fingers and stabilize it against the patient’s skin. Position the bed and examiner to reduce bending and twisting and maintain a clear view. Ultrasound tissues are distinguished by echogenicity, echotexture, and compressibility. Tendons and ligaments are bright, appearing polka-dot-like in short axis and fibrillar in long axis. Muscle has a mixed, “starry night” short-axis pattern and a feather-like long-axis pattern. Nerves have a mixed honeycomb appearance in short axis and a striated, bundle-like pattern in long axis. Vessels are anechoic, and bone is hyperechoic.

<strong>Upper-limb nerve pathways and landmarks:</strong>
- <strong>Median nerve:</strong> At the elbow, assess near the brachial artery, biceps tendon, brachialis, and pronator teres. In the forearm, relevant landmarks include the flexor muscles and pronator quadratus. At the wrist, identify the carpal bones and flexor tendons.
- <strong>Ulnar nerve:</strong> At the elbow, assess near the common flexor bundle and flexor carpi ulnaris. In the forearm, follow it alongside the ulnar artery and flexor muscles. At the wrist, track it to the hook of the hamate, where it divides into superficial and deep branches.
- <strong>Radial nerve:</strong> At the elbow, use the radiohumeral joint, common extensor bundle, brachioradialis, and brachialis as landmarks. In the forearm, follow it near the extensor muscles and supinator. At the wrist, identify Lister’s tubercle and the six dorsal extensor compartments.

Keywords

musculoskeletal ultrasound

upper limb

nerve ultrasound

image optimization

transducer frequency

probe technique

median nerve

ulnar nerve

radial nerve

anatomical landmarks