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Technique of ultrasound of the upper extremity
Last reviewed: 06.07.2025
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Survey methodology and obtained data
When examining the veins of the upper limb, the patient lies supine with the upper end of the body slightly elevated. Place the patient's arm on your lap and hold it in the desired position with your left hand. Start the examination at the supraclavicular level with a medium or high frequency (5-10 MHz) transducer. The transducer surface should be less than 4 cm wide to facilitate penetration of the supraclavicular fossa. Obtain a color image of the proximal subclavian vein. Then trace the internal jugular vein superiorly in cross-section from its confluence with the subclavian vein, using alternating compression, as high toward the head as possible. If the results are normal, B-mode is sufficient. Then continue the examination inferiorly from the clavicle. When scanning through the pectoral window, the veins are deep, so a low frequency transducer should be used. Start scanning immediately below the clavicle, tracing the vessels to the anterior axillary fornix. Then scan from the axillary approach, making sure to overlap the axillary images with the thoracic images to avoid missing portions of the axillary vein. When examining distal to the level of the axilla, lower the arm down to improve visualization of the veins. If desired, you can attempt to visualize the brachiocephalic vein from the supraclavicular approach with a high-frequency probe. Examination of the forearm veins is usually not necessary.
Ultrasound anatomy
Examination of the veins of the upper limb is complicated by the fact that the subclavian vein is “hidden” behind the clavicle. The supraclavicular portion of the vein is anterior to the subclavian artery. Since the transducer is inclined toward the clavicle, the vein is usually visualized only in longitudinal section. At the subclavian level, the transducer is positioned perpendicularly, with its upper end touching the clavicle. It moves along the bone to visualize the subclavian vessels in the medial and middle thirds of the clavicle. The vein runs anterior to the artery, merging with the axillary vein at the lateral edge of the first rib. The brachial veins and anterior brachial veins have a narrower caliber and are of lesser clinical significance.
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