[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"menu":3,"$fiQEw4hHkmw9dAxNGcweDTLJlp01rS_mIP0T0UTWUT_8":210},{"main":4,"mainTranslated":17,"footer":45,"footerTranslated":109},[5,8,11,14],{"title":6,"url":7},"Course library","https:\u002F\u002Fwww.medmastery.com\u002Fcourse-library",{"title":9,"url":10},"Pricing","https:\u002F\u002Fwww.medmastery.com\u002Fpricing",{"title":12,"url":13},"Earn credits","https:\u002F\u002Fwww.medmastery.com\u002Fcme-credits",{"title":15,"url":16},"Institutions","https:\u002F\u002Fwww.medmastery.com\u002Finstitutions",{"de":18,"es":27,"fr":36},[19,21,23,25],{"title":20,"url":7},"Kurse",{"title":22,"url":10},"Preise",{"title":24,"url":13},"CME-Punkte",{"title":26,"url":16},"Organisationen",[28,30,32,34],{"title":29,"url":7},"Biblioteca de cursos",{"title":31,"url":10},"Precios",{"title":33,"url":13},"Gana créditos",{"title":35,"url":16},"Instituciones",[37,39,41,43],{"title":38,"url":7},"Cours",{"title":40,"url":10},"Tarifs",{"title":42,"url":13},"Obtenir des crédits",{"title":44,"url":16},"Établissements",[46,59,79,97],{"title":47,"group":48,"menu":49},"Company",true,[50,53,56],{"title":51,"url":52},"Our teachers","https:\u002F\u002Fwww.medmastery.com\u002Fteachers",{"title":54,"url":55},"About us","https:\u002F\u002Fwww.medmastery.com\u002Fabout-us",{"title":57,"url":58},"Work with us","https:\u002F\u002Fwww.medmastery.com\u002Fwork-with-us",{"title":60,"group":48,"menu":61},"Product",[62,64,67,70,73,76,78],{"title":63,"url":7},"Courses",{"title":65,"url":66},"Magazine","https:\u002F\u002Fwww.medmastery.com\u002Fmagazine",{"title":68,"url":69},"Podcast","https:\u002F\u002Fwww.medmastery.com\u002Fpodcasts",{"title":71,"url":72},"Webinars","https:\u002F\u002Fwww.medmastery.com\u002Fwebinars",{"title":74,"url":75},"Guides","https:\u002F\u002Fwww.medmastery.com\u002Fguides",{"title":15,"url":77},"https:\u002F\u002Fwww.medmastery.com\u002Finstitutions\u002F",{"title":9,"url":10},{"title":80,"group":48,"menu":81},"Legal",[82,85,88,91,94],{"title":83,"url":84},"Imprint","https:\u002F\u002Fwww.medmastery.com\u002Fimprint",{"title":86,"url":87},"Newsletter policy","https:\u002F\u002Fwww.medmastery.com\u002Fnewsletter-privacy-policy",{"title":89,"url":90},"Privacy policy","https:\u002F\u002Fwww.medmastery.com\u002Fprivacy-policy",{"title":92,"url":93},"Cookie Policy","https:\u002F\u002Fwww.medmastery.com\u002Fcookie-policy",{"title":95,"url":96},"Terms","https:\u002F\u002Fwww.medmastery.com\u002Fterms",{"title":98,"group":48,"menu":99},"Customer support",[100,103,106],{"title":101,"url":102},"FAQs","https:\u002F\u002Fwww.medmastery.com\u002Ffaqs",{"title":104,"url":105},"Contact","https:\u002F\u002Fwww.medmastery.com\u002Fcontact",{"title":107,"url":108},"support@medmastery.com","mailto:support@medmastery.com",{"de":110,"es":143,"fr":177},[111,118,128,137],{"title":112,"group":48,"menu":113},"Unternehmen",[114,116,117],{"title":115,"url":52},"Unsere Dozentinnen und Dozenten",{"title":54,"url":55},{"title":57,"url":58},{"title":119,"group":48,"menu":120},"Produkt",[121,122,123,124,125,126,127],{"title":20,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":26,"url":77},{"title":22,"url":10},{"title":129,"group":48,"menu":130},"Rechtliches",[131,133,134,135,136],{"title":132,"url":84},"Impressum",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":138,"group":48,"menu":139},"Kundenservice",[140,141,142],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[144,151,162,171],{"title":145,"group":48,"menu":146},"Empresa",[147,149,150],{"title":148,"url":52},"Nuestros profesores",{"title":54,"url":55},{"title":57,"url":58},{"title":152,"group":48,"menu":153},"Producto",[154,156,157,158,159,160,161],{"title":155,"url":7},"Cursos",{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":35,"url":77},{"title":31,"url":10},{"title":163,"group":48,"menu":164},"Información legal",[165,167,168,169,170],{"title":166,"url":84},"Aviso legal",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":172,"group":48,"menu":173},"Atención al cliente",[174,175,176],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[178,185,196,204],{"title":179,"group":48,"menu":180},"Entreprise",[181,183,184],{"title":182,"url":52},"Nos enseignants",{"title":54,"url":55},{"title":57,"url":58},{"title":186,"group":48,"menu":187},"Produit",[188,189,190,191,192,193,194],{"title":38,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":15,"url":77},{"title":195,"url":10},"Tarification",{"title":197,"group":48,"menu":198},"Mentions légales",[199,200,201,202,203],{"title":197,"url":84},{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":205,"group":48,"menu":206},"Service client",[207,208,209],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},{"content":211,"related":283,"meta":354,"internal":364},{"title":212,"leadIn":213,"category":214,"elements":217,"becomeAnExpert":251,"author":273,"readDuration":281,"readDurationFormatted":282},"Distinguishing nerves using ultrasound","Learn how to recognize soft tissue structures using ultrasound.",{"id":215,"name":216},1,"Course previews",[218,229,234,239,246],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},469,{"platform":223,"name":224,"url":225,"size":226},"YouTube","Distinguishing nerves from surrounding structures","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=icZmHvUt0hs",{"width":227,"height":228},200,113,{"type":230,"data":231},"free_text",{"readDurationInSeconds":232,"text":233},11.2,"\u003Cp>The first step to a successful nerve block is to distinguish the nerves you need to anesthetize. Ultrasound makes this process much easier! With our Ultrasound-Guided Nerve Block Masterclass, you'll learn how to easily recognize soft tissue structures using ultrasound, as well as distinguish nerves from their surrounding structures.\u003C\u002Fp>",{"type":230,"data":235},{"readDurationInSeconds":236,"title":237,"text":238},13.6,"Join our Ultrasound-Guided Nerve Block Masterclass course today!","\u003Cp>Master the use of ultrasound to guide your nerve block procedures with our \u003Cstrong>\u003Ca href=\"https:\u002F\u002Fwww.medmastery.com\u002Fcourse\u002Fnerve-block-masterclass\">Ultrasound-Guided Nerve Block Masterclass\u003C\u002Fa>\u003C\u002Fstrong>! You'll learn how to identify and anesthetize nerves in the neck, torso, and lower extremities with the help of ultrasound, and build an appropriate nerve block protocol within your hospital. \u003C\u002Fp>",{"type":240,"data":241},"cta",{"readDurationInSeconds":242,"text":243,"buttonText":244,"buttonUrl":245},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":230,"data":247},{"readDurationInSeconds":248,"title":249,"text":250},198.93333333333334,"Video Transcript","\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:00] \u003C\u002Fstrong>Before we dive deep into nerve blocks, it is critical that we amass a fundamental understanding of differentiating anatomical structures, with ultrasound. That is how certain structures such as bone, tendon, muscles, and nerves appear with ultrasound and how to distinguish them from one another. First and foremost—nerves, that is, of course, the topic of the course. Nerves appear honeycomb-like. The \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:00:30]\u003C\u002Fstrong> fascicles inside them take on this honeycomb appearance. As you can see here in your screen, in the middle of your screen, a nerve bundle. Notice the small little fascicles within its core. Also, notice how bright it is compared to the surrounding tissue over here, over here, up here. This is called hyperechoic. It has echoes within it. Echo meaning white. When learning ultrasound \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:00]\u003C\u002Fstrong> of any application or indication, whether its nerves or heart or lungs, the tendency is to be hesitant and deliberate with the movement of your probe. I advocate for just the opposite. Don't be bashful, move that probe briskly and watch as the structures underneath dynamically change. Tendons become muscles, nerves stay static in caliber, in size, vessels will compress if you put pressure on them, they will dive deeper \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:01:30]\u003C\u002Fstrong> and more shallow. No better example of this can be seen than in the carpal tunnel. Here, recognize the circular structure superficially. Without moving the probe, it is unclear which of these circular objects is the tendon and which of them is a nerve. They are not black or anechoic, lacking of echoes. So, they are much less likely a vessel. Also, note the \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:00]\u003C\u002Fstrong> hyperechoic or bright white line, just below these circular objects. The bright white line means that the ultrasound waves that are coming from your probe are being blocked. By definition, something that blocks ultrasound waves must be quite dense. In this case, notice the shadow and beyond the hyperechoic rim. This shadowing tells you that this is most \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:02:30] \u003C\u002Fstrong>likely a bone or in this instance, in a carpal tunnel, the carpal bones. Here, watch as we slide that probe briskly up towards the elbow. Notice here how our tendons are becoming muscles. They are changing in size, changing in caliber. See if you can notice the one thing on the screen that stays static. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:00] \u003C\u002Fstrong>This is your median nerve. Notice it here. Watch it from the beginning. See if you can identify which circular object is the nerve at the outset. Perfect. Here's a still image of the median nerve in the proximal forearm. Notice that honeycomb-like appearance and that hyperechogenicity, bright white. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:03:30] \u003C\u002Fstrong>Notice the muscle tissues surrounding it as well as the hyperechoic fascial lines here. Notice the difference between hyperechoic fascia and that hyperechoic bone we saw. Remember the bone shadows, the fascia is not dense enough to block all the waves so some of the waves as you can see pass through. Lastly, I want you to draw your attention to the top left of your screen at the circular anechoic \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:04:00]\u003C\u002Fstrong> object. Without putting pressure on the probe, I can't tell whether this is vein or artery, however, I know it is one or the other. So, to lead into distinguishing vascular structures, we need to use compression. Nerves cannot be compressed without any amount of force. Vessels, on the other hand, can be. Watch as I push down on the skin and the vein compresses. \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:04:30]\u003C\u002Fstrong> Tubular anechoic vascular structure, easily compressed. This is a vein. In this image, you'll see examples of nerve, artery, and vein altogether. This association will become a theme in this course, nerves running with vessels. Neurovascular bundles are extremely common in the body. In the arms, in the chest, in the belly, and in the legs. At the top of \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:05:00] \u003C\u002Fstrong>your screen, notice that circular hyperechoic honeycomb-like nerve. Just to the left and inferior to it, will be your vein. At this point, we can't tell the difference, right? We're not actively compressing it. We're not watching Doppler flow to see pulsatile nature. And then just below that is your artery. Watch as we confirm, who we suspect to be true, in the video. See, there \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:05:30]\u003C\u002Fstrong> is the vein, easily compresses and the artery does not. You can also see that moving the probe just slightly gives you a better idea of this static circular hyperechoic nerve. This is the popliteal fossa. We will explore this in a later chapter. So to review, anechoic circular structures, whether they're \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:06:00] \u003C\u002Fstrong>compressed or not compressed are either vein or artery. Echogenic structures, look for a shadow. If you see a shadow, that tells you it is likely bone. If there is no shadow, then that can be either muscle tissue, tendon tissue or nerve tissue. If we look at each of these individually, we want to notice how organized they are. Remember that muscle is not \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:06:30]\u003C\u002Fstrong> as circular and organized as the other tissues. Remember, it changes. Recall the clip of the forearm, as we swept up towards the elbow and the tendons become nerves and became wider. Nerves, on the other hand, will be circular and organized, as will tendons, if you stay in place. So, that brings us into differentiating tendons and nerves. By simply moving your probe along the skin, you can see if \u003C\u002Fp>\u003Cp dir=\"ltr\">\u003Cstrong>[00:07:00]\u003C\u002Fstrong> the nerves or tendons change. Static objects will be your nerves. Changing dynamic structures into muscles will confirm that you are looking at tendon. So, by being active with your probe, not being afraid to move around, especially at the beginning of your learning, you will start to see tissue differently. And by doing so, you will become very comfortable distinguishing nerves from their surrounding structures.\u003C\u002Fp>",{"courses":252,"showAwardsBelow":48},[253],{"id":254,"isFreeCmeCourse":255,"title":256,"type":257,"specialization":258,"teachers":260,"cmeCredits":262,"teacherIllustration":263,"backgroundImage":264,"relativeUrl":265,"lastChanged":266,"created":267,"description":268,"relativeURL":265,"meta":269},4955,false,"Ultrasound-Guided Nerve Block Masterclass","course",[259],"Ultrasound",[261],"Peter Croft, MD",5,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55f0f-f60e-46de-a271-77e8a2593275","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55f10-e5e4-42af-86af-442bcda18a88","\u002Fcourses\u002Fultrasound-guided-nerve-block-masterclass","1769024283","1527155216","Nerve blocks are becoming more common in all fields of medicine for good reason—they are super efficient! Ultrasound guidance enhances success rates, decreases complications, and avoids timely, costly, and occasionally dangerous sedations. This course covers the anatomical and technical fundamentals needed to confidently and safely deliver ultrasound-guided regional anesthesia from head to toe.",{"duration":270,"quizzes":271,"lessons":272},13832,6,45,{"id":274,"name":261,"image":275,"profession":276,"relativeUrl":279,"specializations":280},4956,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf01-1862-4650-8239-bf7fbee12ad3",{"name":277,"description":278},"Emergency medicine physician","Peter is an Associate Professor of Emergency Medicine and Ultrasound Co-Director at Maine Medical Center, Portland, USA.","\u002Fteachers\u002Fpeter-croft-md",[259],231,"4m",[284,312,331],{"id":285,"title":286,"text":287,"image":288,"author":296,"path":305,"readDuration":306,"readDurationFormatted":307,"internal":308},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":289,"title":290,"size":291,"location":293},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":292,"height":292},1200,{"bucket":294,"key":295},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":297,"title":298,"relativeURL":299,"image":300,"professionLong":301,"profession":302,"weight":304},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":303},"Internist",4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":309,"updated":310,"published":311},1778115738,1778118425,1778118255,{"id":313,"title":314,"text":315,"image":316,"author":322,"path":324,"readDuration":325,"readDurationFormatted":326,"internal":327},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":317,"title":290,"size":318,"location":320},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":319,"height":319},600,{"bucket":294,"key":321},"\u002F2026-04\u002FC121_magazine image.png",{"id":297,"title":298,"relativeURL":299,"image":300,"professionLong":301,"profession":323,"weight":304},{"name":303},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":328,"updated":329,"published":330},1777403036,1777572381,1777412421,{"id":332,"title":333,"text":334,"image":335,"author":340,"path":348,"readDuration":349,"readDurationFormatted":282,"internal":350},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":336,"title":290,"size":337,"location":338},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":319,"height":319},{"bucket":294,"key":339},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":341,"title":342,"relativeURL":343,"image":344,"professionLong":345,"profession":346,"weight":347},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":277},1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,{"created":351,"updated":352,"published":353},1776705362,1776710540,1776710541,{"seo":355,"og":357},{"title":356,"description":213},"Distinguishing nerves using ultrasound | Medmastery",{"title":356,"description":213,"image":358},{"alt":290,"title":290,"size":359,"location":362},{"width":360,"height":361},1910,1066,{"bucket":294,"key":363},"\u002Fmigrated-images\u002FScreen Shot 2018-05-29 at 10.33.35 am.png",{"id":365,"created":366,"updated":367,"published":366},224,1528105895,1655189586]