PDF herunterladen
Semin Musculoskelet Radiol 2022; 26(02): 140-152
DOI: 10.1055/s-0042-1742393
Review Article

Nerve Imaging in the Wrist

Steven P. Daniels
1   Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
,
Jadie E. De Tolla
2   Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
,
Ali Azad
2   Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
,
Catherine N. Petchprapa
1   Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Neuropathic symptoms involving the wrist are a common clinical presentation that can be due to a variety of causes. Imaging plays a key role in differentiating distal nerve lesions in the wrist from more proximal nerve abnormalities such as a cervical radiculopathy or brachial plexopathy. Imaging complements electrodiagnostic testing by helping define the specific lesion site and by providing anatomical information to guide surgical planning. This article reviews nerve anatomy, normal and abnormal findings on ultrasonography and magnetic resonance imaging, and common and uncommon causes of neuropathy.

Keywords

wrist - magnetic resonance imaging - ultrasonography - peripheral nerves - carpal tunnel syndrome


Publikationsverlauf

Artikel online veröffentlicht:
24. Mai 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Doughty CT, Bowley MP. Entrapment neuropathies of the upper extremity. Med Clin North Am 2019; 103 (02) 357-370
    CrossrefPubMedGoogle Scholar
  • 2 Saint-Lary O, Rébois A, Mediouni Z, Descatha A. Carpal tunnel syndrome: primary care and occupational factors. Front Med (Lausanne) 2015; 2: 28
    PubMedGoogle Scholar
  • 3 Sneag DB, Arányi Z, Zusstone EM. et al. Fascicular constrictions above elbow typify anterior interosseous nerve syndrome. Muscle Nerve 2020; 61 (03) 301-310
    CrossrefPubMedGoogle Scholar
  • 4 Stewart JD. Peripheral nerve fascicles: anatomy and clinical relevance. Muscle Nerve 2003; 28 (05) 525-541
    CrossrefPubMedGoogle Scholar
  • 5 Sourkes M, Stewart JD. Common peroneal neuropathy: a study of selective motor and sensory involvement. Neurology 1991; 41 (07) 1029-1033
    CrossrefPubMedGoogle Scholar
  • 6 Haig AJ, Tzeng HM, LeBreck DB. The value of electrodiagnostic consultation for patients with upper extremity nerve complaints: a prospective comparison with the history and physical examination. Arch Phys Med Rehabil 1999; 80 (10) 1273-1281
    CrossrefPubMedGoogle Scholar
  • 7 Brown JM, Yablon CM, Morag Y, Brandon CJ, Jacobson JA. US of the peripheral nerves of the upper extremity: a landmark approach. Radiographics 2016; 36 (02) 452-463
    CrossrefPubMedGoogle Scholar
  • 8 Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics 2006; 26 (05) 1267-1287
    CrossrefPubMedGoogle Scholar
  • 9 Kästel T, Heiland S, Bäumer P, Bartsch AJ, Bendszus M, Pham M. Magic angle effect: a relevant artifact in MR neurography at 3T?. AJNR Am J Neuroradiol 2011; 32 (05) 821-827
    CrossrefPubMedGoogle Scholar
  • 10 Sanmugalingam N, Rault MEG, Toms AP. Normal variations in position and relations of the median nerve in the carpal tunnel: a cross-sectional observational study using clinical magnetic resonance imaging. Clin Anat 2020; 33 (04) 598-604
    CrossrefPubMedGoogle Scholar
  • 11 Smith JL, Ebraheim NA. Anatomy of the palmar cutaneous branch of the median nerve: a review. J Orthop 2019; 16 (06) 576-579
    CrossrefPubMedGoogle Scholar
  • 12 Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg Am 1977; 2 (01) 44-53
    CrossrefPubMedGoogle Scholar
  • 13 Petrover D, Bellity J, Vigan M, Nizard R, Hakime A. Ultrasound imaging of the thenar motor branch of the median nerve: a cadaveric study. Eur Radiol 2017; 27 (11) 4883-4888
    CrossrefPubMedGoogle Scholar
  • 14 Bayrak IK, Bayrak AO, Kale M, Turker H, Diren B. Bifid median nerve in patients with carpal tunnel syndrome. J Ultrasound Med 2008; 27 (08) 1129-1136
    CrossrefPubMedGoogle Scholar
  • 15 Shinagawa S, Tajika T, Oya N. et al. Prevalence of bifid median nerve and the cross-sectional area as assessed by ultrasonography in healthy Japanese subjects. J Hand Surg Global Online 2019; 1 (02) 74-78
    CrossrefPubMedGoogle Scholar
  • 16 Pierre-Jerome C, Smitson Jr RD, Shah RK, Moncayo V, Abdelnoor M, Terk MR. MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance. Surg Radiol Anat 2010; 32 (03) 315-322
    CrossrefPubMedGoogle Scholar
  • 17 Gassner EM, Schocke M, Peer S, Schwabegger A, Jaschke W, Bodner G. Persistent median artery in the carpal tunnel: color Doppler ultrasonographic findings. J Ultrasound Med 2002; 21 (04) 455-461
    CrossrefPubMedGoogle Scholar
  • 18 Klauser AS, Halpern EJ, De Zordo T. et al. Carpal tunnel syndrome assessment with US: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 2009; 250 (01) 171-177
    CrossrefPubMedGoogle Scholar
  • 19 Lee RKL, Griffith JF, Ng AWH. et al. Cross-sectional area of the median nerve at the wrist: comparison of sonographic, MRI, and cadaveric measurements. J Clin Ultrasound 2019; 47 (03) 122-127
    CrossrefPubMedGoogle Scholar
  • 20 Ng AWH, Griffith JF, Tong CSL. et al. MRI criteria for diagnosis and predicting severity of carpal tunnel syndrome. Skeletal Radiol 2020; 49 (03) 397-405
    CrossrefPubMedGoogle Scholar
  • 21 Milone MT, Karim A, Klifto CS, Capo JT. Analysis of expected costs of carpal tunnel syndrome treatment strategies. Hand (N Y) 2019; 14 (03) 317-323
    CrossrefPubMedGoogle Scholar
  • 22 Ostergaard PJ, Meyer MA, Earp BE. Non-operative treatment of carpal tunnel syndrome. Curr Rev Musculoskelet Med 2020; 13 (02) 141-147
    CrossrefPubMedGoogle Scholar
  • 23 Patel K, Horak HA. Electrodiagnosis of common mononeuropathies: median, ulnar, and fibular (peroneal) neuropathies. Neurol Clin 2021; 39 (04) 939-955
    CrossrefPubMedGoogle Scholar
  • 24 Witt JC, Hentz JG, Stevens JC. Carpal tunnel syndrome with normal nerve conduction studies. Muscle Nerve 2004; 29 (04) 515-522
    CrossrefPubMedGoogle Scholar
  • 25 Pan TJ, Byrne K, Fowler J. False positive rates of electrodiagnostic studies compared to ultrasound examination for carpal tunnel syndrome: level 4 evidence. J Hand Surg Am 2017; 42 (09) S9
    CrossrefPubMedGoogle Scholar
  • 26 Fowler JR, Munsch M, Tosti R, Hagberg WC, Imbriglia JE. Comparison of ultrasound and electrodiagnostic testing for diagnosis of carpal tunnel syndrome: study using a validated clinical tool as the reference standard. J Bone Joint Surg Am 2014; 96 (17) e148
    CrossrefPubMedGoogle Scholar
  • 27 Wong SM, Griffith JF, Hui ACF, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology 2004; 232 (01) 93-99
    CrossrefPubMedGoogle Scholar
  • 28 Ng AWH, Griffith JF, Lee RKL, Tse WL, Wong CWY, Ho PC. Ultrasound carpal tunnel syndrome: additional criteria for diagnosis. Clin Radiol 2018; 73 (02) 214.e11-214.e18
    CrossrefPubMedGoogle Scholar
  • 29 Klauser AS, Abd Ellah MMH, Halpern EJ. et al. Sonographic cross-sectional area measurement in carpal tunnel syndrome patients: can delta and ratio calculations predict severity compared to nerve conduction studies?. Eur Radiol 2015; 25 (08) 2419-2427
    CrossrefPubMedGoogle Scholar
  • 30 Klauser AS, Halpern EJ, Faschingbauer R. et al. Bifid median nerve in carpal tunnel syndrome: assessment with US cross-sectional area measurement. Radiology 2011; 259 (03) 808-815
    CrossrefPubMedGoogle Scholar
  • 31 Gonzalez-Suarez CB, Fidel BC, Cabrera JTC. et al. Diagnostic accuracy of ultrasound parameters in carpal tunnel syndrome: additional criteria for diagnosis. J Ultrasound Med 2019; 38 (11) 3043-3052
    CrossrefPubMedGoogle Scholar
  • 32 Ooi CC, Wong SK, Tan ABH. et al. Diagnostic criteria of carpal tunnel syndrome using high-resolution ultrasonography: correlation with nerve conduction studies. Skeletal Radiol 2014; 43 (10) 1387-1394
    CrossrefPubMedGoogle Scholar
  • 33 Filler AG, Kliot M, Howe FA. et al. Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology. J Neurosurg 1996; 85 (02) 299-309
    CrossrefPubMedGoogle Scholar
  • 34 Chen CH, Wu T, Sun JS, Lin WH, Chen CY. Unusual causes of carpal tunnel syndrome: space occupying lesions. J Hand Surg Eur Vol 2012; 37 (01) 14-19
    CrossrefPubMedGoogle Scholar
  • 35 Pirola E, Hébert-Blouin MN, Amador N, Amrami KK, Spinner RJ. Palmaris profundus: one name, several subtypes, and a shared potential for nerve compression. Clin Anat 2009; 22 (06) 643-648
    CrossrefPubMedGoogle Scholar
  • 36 Pfirrmann CWA, Zanetti M. Variants, pitfalls and asymptomatic findings in wrist and hand imaging. Eur J Radiol 2005; 56 (03) 286-295
    CrossrefPubMedGoogle Scholar
  • 37 Donnelly JP, Hanna M, Sperry BW, Seitz Jr WH. Carpal tunnel syndrome: a potential early, red-flag sign of amyloidosis. J Hand Surg Am 2019; 44 (10) 868-876
    CrossrefPubMedGoogle Scholar
  • 38 Mosier BA, Hughes TB. Recurrent carpal tunnel syndrome. Hand Clin 2013; 29 (03) 427-434
    CrossrefPubMedGoogle Scholar
  • 39 Ng AWH, Griffith JF, Tsoi C. et al. Ultrasonography findings of the carpal tunnel after endoscopic carpal tunnel release for carpal tunnel syndrome. Korean J Radiol 2021; 22 (07) 1132-1141
    CrossrefPubMedGoogle Scholar
  • 40 Fadel ZT, Samargandi OA, Tang DT. Variations in the anatomical structures of the Guyon canal. Plast Surg (Oakv) 2017; 25 (02) 84-92
    CrossrefPubMedGoogle Scholar
  • 41 Blum AG, Zabel JP, Kohlmann R. et al. Pathologic conditions of the hypothenar eminence: evaluation with multidetector CT and MR imaging. Radiographics 2006; 26 (04) 1021-1044
    CrossrefPubMedGoogle Scholar
  • 42 Reckelhoff KE, Li J, Kaeser MA, Haun DW, Kettner NW. Ultrasound evaluation of the normal ulnar nerve in Guyon's tunnel: cross-sectional area and anthropometric measurements. J Med Ultrasound 2015; 23 (04) 171-176
    CrossrefPubMedGoogle Scholar
  • 43 Iyer VG. Ultrasonography in distal ulnar nerve neuropathy: findings in 33 patients. J Clin Neurophysiol 2021; 38 (02) 156-159
    CrossrefPubMedGoogle Scholar
  • 44 Zeiss J, Jakab E, Khimji T, Imbriglia J. The ulnar tunnel at the wrist (Guyon's canal): normal MR anatomy and variants. AJR Am J Roentgenol 1992; 158 (05) 1081-1085
    CrossrefPubMedGoogle Scholar
  • 45 Earp BE, Floyd WE, Louie D, Koris M, Protomastro P. Ulnar nerve entrapment at the wrist. J Am Acad Orthop Surg 2014; 22 (11) 699-706
    CrossrefPubMedGoogle Scholar
  • 46 Brubacher JW, Leversedge FJ. Ulnar neuropathy in cyclists. Hand Clin 2017; 33 (01) 199-205
    CrossrefPubMedGoogle Scholar
  • 47 Gross MS, Gelberman RH. The anatomy of the distal ulnar tunnel. Clin Orthop Relat Res 1985; (196) 238-247
    PubMedGoogle Scholar
  • 48 Landau ME, Campbell WW. Clinical features and electrodiagnosis of ulnar neuropathies. Phys Med Rehabil Clin N Am 2013; 24 (01) 49-66
    CrossrefPubMedGoogle Scholar
  • 49 Campion D. Electrodiagnostic testing in hand surgery. J Hand Surg Am 1996; 21 (06) 947-956
    CrossrefPubMedGoogle Scholar
  • 50 Kollmer J, Bäumer P, Milford D. et al. T2-signal of ulnar nerve branches at the wrist in Guyon's canal syndrome. PLoS One 2012; 7 (10) e47295
    CrossrefPubMedGoogle Scholar
  • 51 Ruocco MJ, Walsh JJ, Jackson JP. MR imaging of ulnar nerve entrapment secondary to an anomalous wrist muscle. Skeletal Radiol 1998; 27 (04) 218-221
    CrossrefPubMedGoogle Scholar
  • 52 Claassen H, Schmitt O, Schulze M, Wree A. Variation in the hypothenar muscles and its impact on ulnar tunnel syndrome. Surg Radiol Anat 2013; 35 (10) 893-899
    CrossrefPubMedGoogle Scholar
  • 53 Harvie P, Patel N, Ostlere SJ. Prevalence and epidemiological variation of anomalous muscles at Guyon's canal. J Hand Surg [Br] 2004; 29 (01) 26-29
    CrossrefPubMedGoogle Scholar
  • 54 Waugh RP, Pellegrini Jr VD. Ulnar tunnel syndrome. Hand Clin 2007; 23 (03) 301-310 , v
    CrossrefPubMedGoogle Scholar
  • 55 Murata K, Shih JT, Tsai TM. Causes of ulnar tunnel syndrome: a retrospective study of 31 subjects. J Hand Surg Am 2003; 28 (04) 647-651
    CrossrefPubMedGoogle Scholar
  • 56 Feldman MD, Rotman MB, Manske PR. Compression of the deep motor branch of the ulnar nerve by a midpalmar ganglion. Orthopedics 1995; 18 (01) 65-67
    CrossrefPubMedGoogle Scholar
  • 57 Duggal A, Anastakis DJ, Salonen D, Becker E. Compression of the deep palmar branch of the ulnar nerve by a ganglion : a case report. Hand (N Y) 2006; 1 (02) 98-101
    CrossrefPubMedGoogle Scholar
  • 58 Marx SC, Dhalapathy S, Marx CA, Babu MS, Pulakunta T, Vasanthakumar S. Ultrasonographical and histological cross-sectional study of the human superficial branch of the radial nerve. Rom J Morphol Embryol 2011; 52 (3, Suppl): 1081-1090
    PubMedGoogle Scholar
  • 59 Kim KH, Byun EJ, Oh EH. Ultrasonographic findings of superficial radial nerve and cephalic vein. Ann Rehabil Med 2014; 38 (01) 52-56
    CrossrefPubMedGoogle Scholar
  • 60 Zwart K, Roeling TAP, van Leeuwen WF, Schuurman AH. An anatomical study to the branching pattern of the posterior interosseous nerve on the dorsal side of the hand. Clin Anat 2020; 33 (05) 678-682
    CrossrefPubMedGoogle Scholar
  • 61 Rizzo M, Berger RA, Steinmann SP, Bishop AT. Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-year follow-up period. J Hand Surg Am 2004; 29 (01) 59-62
    CrossrefPubMedGoogle Scholar
  • 62 Lanzetta M, Foucher G. Entrapment of the superficial branch of the radial nerve (Wartenberg's syndrome). A report of 52 cases. Int Orthop 1993; 17 (06) 342-345
    CrossrefPubMedGoogle Scholar
  • 63 Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part I: radial nerve. J Hand Surg Am 2009; 34 (10) 1906-1914
    CrossrefPubMedGoogle Scholar
  • 64 Grant AC, Cook AA. A prospective study of handcuff neuropathies. Muscle Nerve 2000; 23 (06) 933-938
    CrossrefPubMedGoogle Scholar
  • 65 De Maeseneer M, Marcelis S, Jager T, Girard C, Gest T, Jamadar D. Spectrum of normal and pathologic findings in the region of the first extensor compartment of the wrist: sonographic findings and correlations with dissections. J Ultrasound Med 2009; 28 (06) 779-786
    CrossrefPubMedGoogle Scholar
  • 66 Silverman TA, Enzinger FM. Fibrolipomatous hamartoma of nerve. A clinicopathologic analysis of 26 cases. Am J Surg Pathol 1985; 9 (01) 7-14
    CrossrefPubMedGoogle Scholar
  • 67 Toms AP, Anastakis D, Bleakney RR, Marshall TJ. Lipofibromatous hamartoma of the upper extremity: a review of the radiologic findings for 15 patients. AJR Am J Roentgenol 2006; 186 (03) 805-811
    CrossrefPubMedGoogle Scholar
  • 68 Marom EM, Helms CA. Fibrolipomatous hamartoma: pathognomonic on MR imaging. Skeletal Radiol 1999; 28 (05) 260-264
    CrossrefPubMedGoogle Scholar
  • 69 Reynolds Jr DL, Jacobson JA, Inampudi P, Jamadar DA, Ebrahim FS, Hayes CW. Sonographic characteristics of peripheral nerve sheath tumors. AJR Am J Roentgenol 2004; 182 (03) 741-744
    CrossrefPubMedGoogle Scholar
  • 70 Kakkar C, Shetty CM, Koteshwara P, Bajpai S. Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging. Indian J Radiol Imaging 2015; 25 (04) 453-458
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 71 Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma 1998; 45 (01) 116-122
    CrossrefPubMedGoogle Scholar
  • 72 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74 (04) 491-516
    CrossrefPubMedGoogle Scholar
  • 73 Grinsell D, Keating CP, Keating CP. Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. BioMed Res Int 2014; 2014: 698256
    CrossrefPubMedGoogle Scholar
  • 74 Campbell WW. Evaluation and management of peripheral nerve injury. Clin Neurophysiol 2008; 119 (09) 1951-1965
    CrossrefPubMedGoogle Scholar
  • 75 Dvali L, Mackinnon S. Nerve repair, grafting, and nerve transfers. Clin Plast Surg 2003; 30 (02) 203-221
    CrossrefPubMedGoogle Scholar