ImagingGeneral use and techniqueMedian nerve assessmentRadial nerve assessmentUlnar nerve assessment
Magnetic resonance imagingFat-suppressed highly T2-weighted images demonstrate nerve pathology the best
Low slice thickness: 2 mm to 3 mm in distal extremity and 4 mm to 5 mm in proximal extremity
Identify anatomic abnormalities such as ganglion cysts or bony abnormalities
Rule out other causes by identifying abnormalities of surrounding soft tissues
Evaluate for muscle denervation
Evaluate for nerve tumors
Carpal tunnel syndrome: evaluate persistent nerve distress and/or inadequate surgical releasePosterior interosseous nerve: thickened superficial head of supinator (most common entrapment point of posterior interosseous nerve), denervation of the supinator muscle
Superficial radial nerve: imaging of choice for evaluation of surrounding muscle
Cubital tunnel syndrome: perform with extended elbow, shows nerve enlargement, external compression by loose bodies or space-occupying lesions, and regional inflammatory and denervation changes
Guyon canal: useful for persistent symptoms with normal electromyography or tumor noted on ultrasonography
UltrasonographyUse high-resolution (15 to 18 MHz) transducers
Identify causes of entrapment such as fibrous bands, ganglion cysts, anomalous muscles, and bony abnormalities
Evaluate for changes in nerve thickness (by cross-sectional area) and fascicular appearance
Assessment of nerve and surrounding tissue vascularization
Easy comparison to contralateral arm
Dynamic testing
Carpal tunnel syndrome: assess nerve thickness within the carpal tunnel and pronator quadratus for a change greater than 2 mmPosterior interosseous nerve: superficial nerve is easy to visualize, enlargement and hypoechogenicity of the nerve can be seenCubital tunnel syndrome: nerve appears enlarged and hypoechoic, loss of normal fibrillar appearance; comparison of cross section to contralateral side, shows dynamic snapping of nerve
Guyon canal: shows thickened and hypoechoic nerve and ganglion cyst or accessory muscle