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Ultrasonographic evaluation of the median nerve: normal and variant anatomy and appearance

Kitija Nulle
Kitija Nulle
 und 
Aija Jaudzema
Aija Jaudzema
   | 15. Dez. 2021
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Article Category: research-article
Online veröffentlicht: 15. Dez. 2021
Seitenbereich: 318 - 325
Eingereicht: 25. Mai 2021
Akzeptiert: 22. Juni 2021
DOI: https://doi.org/10.15557/jou.2021.0053
Schlüsselwörter
© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Transverse grayscale US of normal median nerve at proximal border of pronator quadratus muscle (A, B), proximal to carpal tunnel inlet (C, D), at tunnel inlet (E, F) and at tunnel outlet (G). Orange dotted circle and M – median nerve; FPL – flexor pollicis longus muscle; FDS – flexor digitorum superficialis muscle; PQ – pronator quadratus muscle; FCR – flexor carpi radialis muscle; FDP – flexor digitorum profundus muscle; R – radius; white dotted line – os lunatum; pink dotted line – flexor retinaculum. Reference: Medical Imaging. Riga East Clinical University Hospital
Transverse grayscale US of normal median nerve at proximal border of pronator quadratus muscle (A, B), proximal to carpal tunnel inlet (C, D), at tunnel inlet (E, F) and at tunnel outlet (G). Orange dotted circle and M – median nerve; FPL – flexor pollicis longus muscle; FDS – flexor digitorum superficialis muscle; PQ – pronator quadratus muscle; FCR – flexor carpi radialis muscle; FDP – flexor digitorum profundus muscle; R – radius; white dotted line – os lunatum; pink dotted line – flexor retinaculum. Reference: Medical Imaging. Riga East Clinical University Hospital

Fig. 2.

Transverse sonography over the proximal humeral head of pronator teres muscle depicting median nerve (white arrow) running deep between humeral head of pronator muscle (PTHH) and brachial anterior muscle (BA), with nerve located distally to brachial artery (black arrow)(17)
Transverse sonography over the proximal humeral head of pronator teres muscle depicting median nerve (white arrow) running deep between humeral head of pronator muscle (PTHH) and brachial anterior muscle (BA), with nerve located distally to brachial artery (black arrow)(17)

Fig. 3.

Lanz classification of median nerve anatomical variations at the wrist. Group I, thenar branch variations; 1A: Subligamentous; 1B: Transligamentous; 1C: Ulnarwards; 1D: Supraligamentous. Group 0, extraligamentous thenar branch. Group II, distal accessory thenar branch. Group IV, proximal accessory thenar branch; 4A: Running directly in the thenar muscles; 4B: Joining another branch. Group III, high division of the median nerve; 3A: Without artery of muscle; 3B: With artery; 3C: With lumbrical muscle(18)
Lanz classification of median nerve anatomical variations at the wrist. Group I, thenar branch variations; 1A: Subligamentous; 1B: Transligamentous; 1C: Ulnarwards; 1D: Supraligamentous. Group 0, extraligamentous thenar branch. Group II, distal accessory thenar branch. Group IV, proximal accessory thenar branch; 4A: Running directly in the thenar muscles; 4B: Joining another branch. Group III, high division of the median nerve; 3A: Without artery of muscle; 3B: With artery; 3C: With lumbrical muscle(18)

Fig. 4.

Transverse ultrasonographic image and marked image of bifid median nerve (white arrowhead) and persistent median artery (white arrow)(19)
Transverse ultrasonographic image and marked image of bifid median nerve (white arrowhead) and persistent median artery (white arrow)(19)

Fig. 5.

Transverse ultrasonographic image and marked image of trifurcation of median nerve at the level of carpal canal (white arrows). Reference: Medical Imaging. Riga East Clinical University Hospital
Transverse ultrasonographic image and marked image of trifurcation of median nerve at the level of carpal canal (white arrows). Reference: Medical Imaging. Riga East Clinical University Hospital

Fig. 6.

Patterns of connection between musculocutaneous and median nerves. cb, coracobrachialis muscle; lc, lateral cord; mc, medial cord; Mc, musculocutaneous nerve; M, median nerve; U, ulnar nerve(8)
Patterns of connection between musculocutaneous and median nerves. cb, coracobrachialis muscle; lc, lateral cord; mc, medial cord; Mc, musculocutaneous nerve; M, median nerve; U, ulnar nerve(8)

Fig. 7.

Transverse sonography showing Martin-Gruber anastomosis (MGA) branching off of median nerve (MED) 5 cm distal to olecranon (A) and running mediocaudally (B, C) and joining ulnar nerve (ULN) (D)(20)
Transverse sonography showing Martin-Gruber anastomosis (MGA) branching off of median nerve (MED) 5 cm distal to olecranon (A) and running mediocaudally (B, C) and joining ulnar nerve (ULN) (D)(20)

Fig. 8.

Summary of main anatomical interneural anastomosis of median nerve: MartinGruber anastomosis ‒ anastomosis from the main trunk of median nerve or interosseous anterior nerve to ulnar nerve; Marinacci anastomosis ‒ the reverse of Martin-Gruber anastomosis ulnar-to-median communication; Berretini anastomosis – communications between common digital nerves that arise from ulnar and median nerves in the palmar surface of hand; Riche-Cannieu anastomosis ‒ connection between the deep branch of ulnar nerve and recurrent branch of median nerve at thenar eminence(1)
Summary of main anatomical interneural anastomosis of median nerve: MartinGruber anastomosis ‒ anastomosis from the main trunk of median nerve or interosseous anterior nerve to ulnar nerve; Marinacci anastomosis ‒ the reverse of Martin-Gruber anastomosis ulnar-to-median communication; Berretini anastomosis – communications between common digital nerves that arise from ulnar and median nerves in the palmar surface of hand; Riche-Cannieu anastomosis ‒ connection between the deep branch of ulnar nerve and recurrent branch of median nerve at thenar eminence(1)

Fig. 9.

Transverse grayscale US of median nerve in upper arm; orange dotted circle – median nerve; red dotted circle – brachial artery; blue dotted circle – brachial vein; purple dotted line – biceps brachii muscle. Reference: Medical Imaging. Riga East Clinical University Hospital
Transverse grayscale US of median nerve in upper arm; orange dotted circle – median nerve; red dotted circle – brachial artery; blue dotted circle – brachial vein; purple dotted line – biceps brachii muscle. Reference: Medical Imaging. Riga East Clinical University Hospital

Fig. 10.

Transverse grayscale US of median nerve in forearm. M – median nerve; FDS – flexor digitorum superficialis muscle; FDP – flexor digitorum profundus muscle. Reference: Medical Imaging. Riga East Clinical University Hospital
Transverse grayscale US of median nerve in forearm. M – median nerve; FDS – flexor digitorum superficialis muscle; FDP – flexor digitorum profundus muscle. Reference: Medical Imaging. Riga East Clinical University Hospital

Fig. 11.

Transverse grayscale US of median nerve in carpal tunnel. M – median nerve; FCR – flexor carpi radialis muscle; FDS – flexor digitorum superficialis muscle; FPL -flexor pollicis longus muscle; FDP – flexor digitorum profundus muscle. Reference: Medical Imaging. Riga East Clinical University Hospital
Transverse grayscale US of median nerve in carpal tunnel. M – median nerve; FCR – flexor carpi radialis muscle; FDS – flexor digitorum superficialis muscle; FPL -flexor pollicis longus muscle; FDP – flexor digitorum profundus muscle. Reference: Medical Imaging. Riga East Clinical University Hospital
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