Hi, I’m Theresa Jorgensen and today’s Gulfcoast Hot Tip will teach you how to more confidently locate and follow the median nerve into the carpal tunnel. At the level of the wrist, telling the difference between the median nerve and nearby tendons, can be very difficult. Can you tell which is which If you’re not feeling confident that what you’re looking at is the nerve, there are a few things you can do. First, try beginning more proximal. Place the transducer in transverse orientation, right down, smack down, in the middle of the forearm.
Approximately five centimeters proximal to the flexoret macculum, the median nerve will be its brightest as it courses around the lateral edge of the flexor digitorum profundus. Try this on yourself, and then try it on your friends. I promise it will work. Hello! Straight down. Mid forearm. Can you see it Next. Straight in the middle. Smack in the middle. Absolutely gorgeous. Well maybe not this one. In the midforearm, if you don’t see the nerve right away, try changing the angle of the transducer’s beam by wagging the tail of the transducer slightly.
You’ll see a dramatic change in the echogenicity as you adjust that angel of insonation. Now that your eye is adjusted to that structure, and you truly are confident it is the nerve, start following it distally, by sliding the transducer lower and lower towards the wrist. Remember, as you approach the wrist, as those other tendons come into view, if you get confused, between the tendons, muscles, and nerves, once again, wagging the tail of the transducer, will demonstrate that the tendons and muscles are more affected by anisotropy, than the nerves.
Hot Tips Ultrasound Evaluation of the Median Nerve