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US of Nerve Entrapments in Osteofibrous Tunnels of the Upper and Lower Limbs¹

¹ From the Department of Radiology R, University of Genoa, Largo Rosanna Benzi 8, I-16132 Genoa, Italy (C.M., L.E.D.); the Division of Radiodiagnostics, Hôpital Cantonal Universitaire, Geneva, Switzerland (S.B.); the Radiology Service, Ospedale Santa Corona, Pietra Ligure, Italy (N.G.); the Istituto Giannina Gaslini, Genoa, Italy (M.V.); and the Division of Neurology, E.O. Ospedali Galliera, Genoa, Italy (S.S.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1999 RSNA scientific assembly. Received February 7, 2000; revision requested March 16 and received May 4; accepted May 11. Address correspondence to C.M. (e-mail: martinoli@zeus.newnetworks.it).

The diagnosis of nerve entrapment at osteofibrous tunnels relies primarily on clinical and electrodiagnostic findings. Recently, the refinement of high-frequency broadband transducers with a range of 5–15 MHz, sophisticated focusing in the near field, and sensitive color and power Doppler technology have improved the ability to evaluate peripheral nerve entrapment in osteofibrous tunnels with ultrasonography (US). In the upper limb, osteofibrous tunnels amenable to US examination include the carpal tunnel for the median nerve and the cubital and Guyon tunnels for the ulnar nerve. In the lower limb, these tunnels include the fibular neck for the common peroneal nerve, the tarsal tunnel for the posterior tibial nerve, and the intermetatarsal spaces for the interdigital nerves. High-resolution US allows direct imaging of the involved nerves, as well as documentation of changes in nerve shape and echotexture that occur in compressive syndromes. A spectrum of extrinsic causes of entrapment, such as tenosynovitis, ganglia, soft-tissue tumors, bone and joint abnormalities, and anomalous muscles, can also be diagnosed with US. With continued experience, it is likely that this technique will be increasingly used to evaluate nerve entrapment syndromes.

Index Terms: Extremities, US, 40.1298 • Nerves, peripheral, 40.82 • Nervous system, US, 40.1298

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Invited Commentary • Authors' Response

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