Abstract

Cutaneous nerve entrapment plays an important role in neuropathic pain syndrome. Due to the advancement of ultrasound technology, the cutaneous nerves can be visualized by high-resolution ultrasound. As the cutaneous nerves course superficially in the subcutaneous layer, they are vulnerable to entrapment or collateral damage in traumatic insults. Scanning of the cutaneous nerves is challenging due to fewer anatomic landmarks for referencing. Therefore, the aim of the present article is to summarize the anatomy of the limb cutaneous nerves, to elaborate the scanning techniques, and also to discuss the clinical implications of pertinent entrapment syndromes of the medial brachial cutaneous nerve, intercostobrachial cutaneous nerve, medial antebrachial cutaneous nerve, lateral antebrachial cutaneous nerve, posterior antebrachial cutaneous nerve, superficial branch of the radial nerve, dorsal cutaneous branch of the ulnar nerve, palmar cutaneous branch of the median nerve, anterior femoral cutaneous nerve, posterior femoral cutaneous nerve, lateral femoral cutaneous nerve, sural nerve, and saphenous nerve.

Highlights

  • Cutaneous nerve entrapment syndromes have long been overlooked

  • Traumatic nerve injury during venipuncture is the main cause of Lateral Antebrachial Cutaneous Nerve (LACN) neuropathy

  • The risks of Dorsal Cutaneous Branch of the Ulnar Nerve (DCBUN) neuropathy are similar to those of Superficial Branch of the Radial Nerve (SBRN), e.g., compression by a bracelet or a metal plate fixed over the distal forearm

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Summary

Introduction

Cutaneous nerve entrapment syndromes have long been overlooked. Owing to their superficial course, cutaneous nerves are susceptible to external compression and iatrogenic injuries. Moving the transducer more distally, the SBRN is seen branching from the medial aspect of the radial nerve and descending underneath the brachioradialis muscle. The transducer is placed on the distal third of the ventral forearm to locate the flexor carpi ulnaris muscle, underneath which lies the ulnar nerve. Moving the transducer more distally, the DCBUN is seen branching from the medial aspect of the ulnar nerve. The sural nerve is visualized descending with the small saphenous vein and courses between the Achilles tendon and peroneus muscles at the distal leg. The sural nerve is in proximity to the small saphenous vein and can be injured during surgeries for varicose veins Another cause of nerve injury would be related to Achilles tendon ruptures whereby the nerve may be entrapped by an adjacent hematoma. Common procedures that elicit a saphenous nerve injury include medial arthrotomy, meniscectomy, arthroscopic anterior cruciate ligament repair, and total knee replacement

Anatomy
Scanning Technique
Clinical Implication
11.3. Clinical Implication
12.1. Anatomy
12.2. Scanning Technique
13.3. Clinical Implication
14.1. Anatomy
14.2. Scanning Technique
15.3. Expert Opinion and Future Recommendation
16. Conclusions
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