Surgical and Radiologic Anatomy

, Volume 32, Issue 3, pp 305–314 | Cite as

Ultrasound–anatomic correlation of the peripheral nerves of the upper limb

  • Xavier Bargalló
  • Anna Carrera
  • Xavier Sala-Blanch
  • Gorane Santamaría
  • Rosa Morro
  • Manuel LLusá
  • Rosa Gilabert
Teaching Anatomy



Sonography allows good visualization of the peripheral nerves and the vascular and muscular structures that surround them. Our goals are to provide an easy-to-use atlas that gives accurate information about the locations and relations among the nerves in the different parts of the arm and to correlate it with the probe position and the ultrasound images.

Materials and methods

A cadaver right arm was used for the present study. The arterial and venous vessels were injected with red and blue-colored latex to obtain a better correlation with ultrasound slices from two healthy volunteers. The specimen was frozen and then cut into slices with an average thickness of 2 cm, starting from the lower part of the axilla.


Close correlation was present between the ultrasound and anatomic slices identifying the main muscular, vascular and nervous structures. In the arm, median, ulnar and radial nerves were easily seen because of the proximity to vascular landmark and their size. In the forearm, the ulnar nerve was also easy to identify because of the factors previously mentioned; the median nerve was easy to locate between the flexor digitorum superficialis and profundus muscles. The superficial branch of the radial arm was seen in most cases, although some skill was required.


Ultrasound is a useful tool to identify the main nerves of the upper arm. This atlas indicates the locations and relations among the nerves, correlating with the ultrasound appearance.


Nerve Ultrasound Upper limb Anatomy 


  1. 1.
    Awad IT, Chan V (2005) Ultrasound imaging of peripheral nerves: a need for a new trend. Reg Anesth Pain Med 30(4):385–390Google Scholar
  2. 2.
    Beekman R, Visser LH (2004) High-resolution sonography of the peripheral nervous system: a review of the literature. Eur J Neurol 11:305–314CrossRefPubMedGoogle Scholar
  3. 3.
    De Andres J, Sala-Blanch X (2002) Ultrasound in the practice of brachial plexus anesthesia. Reg Anesth Pain Med 27(1):77–89PubMedGoogle Scholar
  4. 4.
    Fornage BD (1988) Peripheral nerves of the extremities: imaging with US. Radiology 167:179–182PubMedGoogle Scholar
  5. 5.
    Foxall GL, Skinner D, Hardman JG et al (2007) Ultrasound anatomy of the radial nerve in the distal upper arm. Reg Anesth Pain Med 32(3):217–220PubMedGoogle Scholar
  6. 6.
    Gray H (1918) Anatomy of the Human Body. Thoroughly revised and re-edited by Warren H. Lewis. Lea & Febiger, PhiladelphiaGoogle Scholar
  7. 7.
    Karabay N, Toros T, Ademoglu Y et al (2008) Ultrasonographic evaluation of the iatrogenic peripheral nerve injuries in upper extremity. Eur J Radiol. doi: 10.1016/j.ejrad.2008.10.038
  8. 8.
    Martinoli C, Bianchi S, Derchi LE (1999) Tendon and nerve sonography. Radiol Clin North Am 37:691–711CrossRefPubMedGoogle Scholar
  9. 9.
    Martinoli C, Bianchi S, Derchi LE (2000) Ultrasonography of peripheral nerves. Semin Ultrasound CT MR 21(3):205–213CrossRefPubMedGoogle Scholar
  10. 10.
    Martinoli C, Bianchi S, Dahmane M et al (2002) Ultrasound of tendons and nerves. Eur Radiol 12:44–55CrossRefPubMedGoogle Scholar
  11. 11.
    Martinoli C, Bianchi S, Pugliese F et al (2004) Sonography of entrapment neuropathies in the upper limb (wrist excluded). J Clin Ultrasound 32(9):438–450CrossRefPubMedGoogle Scholar
  12. 12.
    McCartney CJ, Xu D, Constantinescu C et al (2007) Ultrasound examination of the peripheral nerves in the forearm. Reg Anesth Pain Med 32(5):434–439PubMedGoogle Scholar
  13. 13.
    Sala-Blanch X, De Andres J (2004) Image-guided techniques for peripheral nerve blocks. Curr Opin Anaesthesiol 17(5):409–415CrossRefPubMedGoogle Scholar
  14. 14.
    Silvestri E, Martinoli C, Derchi LE et al (1995) Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology 197:291–296PubMedGoogle Scholar
  15. 15.
    Solbiati L, De Pra L, Ierace T et al (1985) High-resolution sonography of the recurrent laryngeal nerve: anatomic and pathologic considerations. Am J Roentgenol 145:989–993Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Xavier Bargalló
    • 1
  • Anna Carrera
    • 2
  • Xavier Sala-Blanch
    • 3
  • Gorane Santamaría
    • 1
  • Rosa Morro
    • 2
  • Manuel LLusá
    • 2
  • Rosa Gilabert
    • 1
  1. 1.Department of Radiology (CDIC)Hospital Clínic de BarcelonaBarcelonaSpain
  2. 2.Department of Anatomy, Facultat de MedicinaUniversitat de BarcelonaBarcelonaSpain
  3. 3.Department of AnaesthesiologyHospital Clínic de BarcelonaBarcelonaSpain

Personalised recommendations