Skip to main content

Volar Wrist

  • Chapter
  • First Online:
Manual of Musculoskeletal Ultrasound

Abstract

Musculoskeletal ultrasound is remarkably advantageous in the volar wrist. This chapter describes the specific sonographic criteria for carpal tunnel syndrome and a foolproof method to identify the median nerve. Ultrasound grants us immediate visual access to structures compromising the median nerve, including anatomic variants that may complicate the injection or surgical release of the carpal tunnel. In addition to diagnostic tips for carpal tunnel syndrome, ultrasound can provide helpful information about the best treatment path to symptom resolution. Using ultrasound, we can also diagnose ulnar nerve compromise, including compression of the deep motor branch, a condition that can mimic carpal tunnel syndrome. The ultrasound probe instantly reveals multiple causes of volar wrist pain, including masses and soft tissue swelling, such as ganglion cysts and tenosynovitis.

The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273–84.

    Article  PubMed  Google Scholar 

  2. Greenberg MH, Greer J, Fant JW. Using ultrasound to diagnose carpal tunnel syndrome. The Rheumatologist. 2018.

    Google Scholar 

  3. Kele H. Ultrasonography of the peripheral nervous system. Pers Med. 2012;1(1):417–21.

    Google Scholar 

  4. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve. 2011;44(4):597–607.

    Article  PubMed  Google Scholar 

  5. Atroshi I, Gummesson C, Johnsson R, Ornstein E. Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome. BMC Musculoskelet Disord. 2003;4:9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Koyuncuoglu HR, Kutluhan S, Yesildag A, Oyar O, Guler K, Ozden A. The value of ultrasonographic measurement in carpal tunnel syndrome in patients with negative electrodiagnostic tests. Eur J Radiol. 2005;56(3):365–9.

    Article  PubMed  Google Scholar 

  7. Chiavaras MM, Jacobson JA, Yablon CM, Brigido MK, Girish G. Pitfalls in wrist and hand ultrasound. AJR Am J Roentgenol. 2014;203(3):531–40.

    Article  PubMed  Google Scholar 

  8. Hobson-Webb LD, Massey JM, Juel VC, Sanders DB. The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol. 2008;119(6):1353–7.

    Article  PubMed  Google Scholar 

  9. Klauser AS, Halpern EJ, De Zordo T, Feuchtner GM, Arora R, Gruber J, 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(1):171–7.

    Article  PubMed  Google Scholar 

  10. Lee D, van Holsbeeck MT, Janevski PK, Ganos DL, Ditmars DM, Darian VB. Diagnosis of carpal tunnel syndrome. Ultrasound versus electromyography. Radiol Clin N Am. 1999;37(4):859–72, x.

    Article  CAS  PubMed  Google Scholar 

  11. Bianchi S, Martinoli C. Wrist. In: Ultrasound of the musculoskeletal system. Springer; 2007. p. 425–92.

    Chapter  Google Scholar 

  12. Martinoli C, Serafini G, Bianchi S, Bertolotto M, Gandolfo N, Derchi LE. Ultrasonography of peripheral nerves. J Peripher Nerv Syst. 1996;1(3):169–78.

    CAS  PubMed  Google Scholar 

  13. Pacek CA, Chakan M, Goitz RJ, Kaufmann RA, Li ZM. Morphological analysis of the transverse carpal ligament. Hand (N Y). 2010;5(2):135–40.

    Article  PubMed  Google Scholar 

  14. Marquardt T, Gabra J, Evans P, Seitz W, Li Z-M. Thickness and stiffness adaptations of the transverse carpal ligament associated with carpal tunnel syndrome. J Musculoskelet Res. 2017;19:1650019.

    Article  PubMed Central  Google Scholar 

  15. Bini N, Leclercq C. Anatomical study of the deep branch of the ulnar nerve and application to selective neurectomy in the treatment of spasticity of the first web space. Surg Radiol Anat. 2019;42:253.

    Article  PubMed  Google Scholar 

  16. Evers S, Bryan AJ, Sanders TL, Selles RW, Gelfman R, Amadio PC. Effectiveness of ultrasound-guided compared to blind steroid injections in the treatment of carpal tunnel syndrome. Arthritis Care Res (Hoboken). 2017;69(7):1060–5.

    Article  CAS  PubMed  Google Scholar 

  17. Greenberg MH, Fant JW Jr. Comparison of the effectiveness of ultrasound-guided steroid injections and blind steroid injections in the treatment of carpal tunnel syndrome: comment on the article by Evers et al. Arthritis Care Res (Hoboken). 2018;70(11):1717–8.

    Article  PubMed  Google Scholar 

  18. Riegler G, Pivec C, Platzgummer H, Lieba-Samal D, Brugger P, Jengojan S, et al. High-resolution ultrasound visualization of the recurrent motor branch of the median nerve: normal and first pathological findings. Eur Radiol. 2017;27(7):2941–9.

    Article  PubMed  Google Scholar 

  19. Coraci D, Loreti C, Piccinini G, Doneddu PE, Biscotti S, Padua L. Ulnar neuropathy at wrist: entrapment at a very “congested” site. Neurol Sci. 2018;39(8):1325–31.

    Article  PubMed  Google Scholar 

  20. Ceponis A, Kissin E. Ultrasound of the hand and wrist. In: Kohler MJ, editor. Musculoskeletal ultrasound in rheumatology review. 2nd ed. Springer; 2021. p. 53–82.

    Chapter  Google Scholar 

  21. Kwak K-W, Kim M-S, Chang C-H, Kim S-H. Ulnar nerve compression in Guyon’s canal by ganglion cyst. J Korean Neurosurg Soc. 2011;49(2):139–41.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lee CH, Kim TK, Yoon ES, Dhong ES. Postoperative morphologic analysis of carpal tunnel syndrome using high-resolution ultrasonography. Ann Plast Surg. 2005;54(2):143–6.

    Article  CAS  PubMed  Google Scholar 

  23. Naranjo A, Ojeda S, Rua-Figueroa I, Garcia-Duque O, Fernandez-Palacios J, Carmona L. Limited value of ultrasound assessment in patients with poor outcome after carpal tunnel release surgery. Scand J Rheumatol. 2010;39(5):409–12.

    Article  CAS  PubMed  Google Scholar 

  24. Peetrons PA, Derbali W. Carpal tunnel syndrome. Semin Musculoskelet Radiol. 2013;17(1):28–33.

    Article  PubMed  Google Scholar 

  25. Murabit A, Gnarra M, Mohamed A. Reversed palmaris longus muscle: anatomical variant—case report and literature review. Can J Plast Surg. 2013;21(1):55–6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Smith J, Barnes DE, Barnes KJ, Strakowski JA, Lachman N, Kakar S, et al. Sonographic visualization of thenar motor branch of the median nerve: a cadaveric validation study. PM R. 2017;9(2):159–69.

    Article  PubMed  Google Scholar 

  27. Jacobson JA. Wrist and hand ultrasound. In: Fundamentals of musculoskeletal ultrasound. 3rd ed. Elsevier; 2018.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mark H. Greenberg .

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Greenberg, M.H., Day, A.L., Alradawi, S. (2023). Volar Wrist. In: Manual of Musculoskeletal Ultrasound . Springer, Cham. https://doi.org/10.1007/978-3-031-37416-6_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-37416-6_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-37415-9

  • Online ISBN: 978-3-031-37416-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics