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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
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.
Greenberg MH, Greer J, Fant JW. Using ultrasound to diagnose carpal tunnel syndrome. The Rheumatologist. 2018.
Kele H. Ultrasonography of the peripheral nervous system. Pers Med. 2012;1(1):417–21.
Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve. 2011;44(4):597–607.
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.
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.
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.
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.
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.
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.
Bianchi S, Martinoli C. Wrist. In: Ultrasound of the musculoskeletal system. Springer; 2007. p. 425–92.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Peetrons PA, Derbali W. Carpal tunnel syndrome. Semin Musculoskelet Radiol. 2013;17(1):28–33.
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.
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.
Jacobson JA. Wrist and hand ultrasound. In: Fundamentals of musculoskeletal ultrasound. 3rd ed. Elsevier; 2018.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
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)