가톨릭대학교

재활의학과

김재민

Anatomy of Peripheral Nerve

Contents

• US appearance of nerves

• Scanning technique

• Peripheral nerve pathology

• Nerves of arm

• Nerves of leg

US Appearance of Nerve

• Multiple longitudinal hypoechoic bands

• Fascicular bundle

• Discontinuous bands

Bacigalupo L et al Radiologe 2003

US Appearance of Nerve

• Oval-to-round echogenic sections on

transverse scan

• Internal punctate echoes

• Honeycomb appearance

Bacigalupo L et al Radiologe 2003

US Appearance of Tendon

• Longitudinal scan– Fibrillar pattern of parallel hyperechoic line

– Boundaries of collagen bundles and endotendineum septa

• Transverse scan– Hyperechoic round to ovoid image

– Bright clustered dots

Tendon & Nerve

Martinoli C et al. Eur Radiol 2002

Scanning Technique

• Lifting technique

• Short axial scan

• Oblique and

longitudinal scan

– The focal region

Peripheral Nerve Pathology

• Neural fibrolipoma

• Traumatic neuroma

• Intraneural perineuroma

• Schwannoma

• Nerve entrapment

• Nerve dislocation

Neural Fibrolipoma

• Infiltration of the perineurium and epineurium with

fibrofatty tissue

• More then 80% of cases involve the median nerve

Stuart, RM. et al. Am J Roentgenol 2004

Traumatic Neuroma

Stuart, RM. et al. Am J Roentgenol 2004

Intraneural Perineuroma

• Rare focal neuronal lesion

• Slowly progressive painless mononeuropathy

• Neoplastic perineural cell proliferation

Stuart, RM. et al. Am J Roentgenol 2004

Schwannoma

• Encapsulated tumor

• Within epineurium

Stuart, RM. et al. Am J Roentgenol 2004

Nerve Entrapment - Ulnar

Nerve Entrapment Syndrome

• Nerve shape and echotexure

– Flattening

– Focal reduction at compression region

– Swelling proximal at the level of compression

• Size measurement

• Abnormal findings in the nerve surroundings

– Mass, anomalous muscle, synovitis etc.

• Innerved muscles to identify denervation sign

Nerve Dislocation

Sonography in Neuropathies

Nerves of Arm

• Musculocutaneous nerve

• Dorsal scapular nerve

• Suprascapular nerve

• Axillary nerve

• Radial nerve

• Ulnar nerve

• Median nerve

Musculocutaneous Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Musculocutaneous Nerve

Suprascapular Nerve

• Ganglion cyst

• Lipomas

• Tumor

• Anomalous vein

• Traction injury

• Inflammation

Hochman MG et al. Radiol Clin North Am 2004

Axillary Nerve

• Trauma

• Glenohumeral dislocation

• Fracture of humerus

• Hematoma

• Paralabral cyst

• Teres minor hypertrophy

Martinoli C et al. J Clin Ultrasound 2004

Radial Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Radial Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Radial Nerve

Ulnar Nerve

Ulnar Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Ulnar Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Cubital Tunnel

• Microtrauma

• Bony deformity

• Ganglion cyst

• Mass

• Synovitis

• Variant anconeus

epitrochlearis m.

Ulnar Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Guyon’s Cannel

Martinoli C et al. Radiographics 2000

Median Nerve

Median Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Median Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Median Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Median Nerve

• Kiloh-Nevin syndrome

– Trauma

– Vascular anomalies

– Tendiosis

– Fibrous band

– Anomalus muscle

– Mass

– Bicipital bursa

• Carpal tunnel syndrome

– Overuse

– Inflammatory arthritis

– Swelling related to thyroid

disease, dialysis, pregnancy

– Ganglion cyst

– lipoma

– Tumor

– Gouty tophi

– Anomalous musculature

Carpal Tunnel

Martinoli C et al. Radiographics 2000

Nerves of Leg

• Femoral nerve

• Obturator nerve

• Sciatic nerve

• Peroneal nerve

• Tibial nerve

Femoral & Obturator Nerves

Sciatic Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Sciatic Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Peroneal Nerve

• At fibular head

– Fracture

– Hemorrhage

– Tight cast or boot

– Synovial, ganglion,

meniscal cyst

– Soft tissue tumor

Peroneal Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Tibial Nerve

Tibial Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Tibial Nerve

Manaster BJ et al. Diagnostic and surgical imaging anatomy. 2006

Tibial Nerve

• In popliteal fossa

– Popliteal cyst

– Popliteal muscle rupture

• Tarsal tunnel syndrome

• Morton’s neuroma

Tarsal Tunnel Syndrome

• Bony impingement

• Ganglion cyst

• Neurilemoma

• Tenosynovitis

• Accessory or

hypertrophic muscle

Martinoli C et al. Radiographics 2000

Morton’s Neuroma

• Nerve degeneration

• Endoneurial edema

• Perineurial fibrosis

Martinoli C et al. Radiographics 2000

Nerve Compression Syndrome

Thank you for

your attention!