- [Voiceover] A linear array transducer with a musculoskeletal exam type is used to perform an ultrasound examination of median nerve entrapment. The patient is in a sitting position with the arm flexed and the hand externally rotated. The transducer is placed transversely over the proximal wrist crease, with the orientation marker directed to the patient's right. The flexor retinaculum spans the wrist structures, and is seen as a band-like structure. The bright, hyperechoic surface of the lunate forms the most posterior boundary of the volar wrist. The superficial and deep tendons of the wrist can be seen as light gray oval structures, which are highly subject to anisotropy. The ulnar artery and nerve can be seen in Guyon's canal superficially and on the medial surface of the wrist. The median nerve is a dark, hyperechoic, elliptical shaped, honeycombed, fascicular structure just ulnar to the flexor carpi radialis tendon, in line with the three carpal bones.
The nerve can be distinguished from the tendons by the fact it is less subject to anisotropy, and it remains in constant position with transducer translation. The nerve should remain a constant diameter with movement of the transducer distally in the hand. The transducer should be centered over the median nerve and rotated 90 degrees clockwise. The median nerve will appear as a fascicular structure which lies on top of the similar-appearing flexor tendons. The patient can be instructed to flex their third and fourth finger to cause movement in the tendons, to distinguish them from the overlying nerve. The median nerve should be evaluated for any edema, which will make the nerve more hyperechoic, or swelling, which may occur distal to entrapment.
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