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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!