Anatomy of Peripheral Nerve 가톨릭대학교 재활의학과 김재민

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

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

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

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

Ulnar Nerve

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 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

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 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

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