Safety of Dry Needling of the Pronator Teres Muscle in Cadavers: A Potential Treatment for Pronator Syndrome

Pain Medicine ◽  
2021 ◽  
Author(s):  
César Fernández-de-las-Peñas ◽  
Carlos López-de-Celis ◽  
Jacobo Rodríguez-Sanz ◽  
César Hidalgo-García ◽  
Joseph M Donelly ◽  
...  
Keyword(s):  
Median Nerve ◽  
Biceps Tendon ◽  
Needle Insertion ◽  
Anatomical Landmarks ◽  
Dry Needling ◽  
Stroke Research ◽  
Pronator Teres ◽  
Needle Penetration ◽  
Filiform Needle ◽  
Neurovascular Bundles

Abstract Background Entrapment of the median nerve at the pronator teres muscle can contribute to symptoms in the forearm and wrist. The pronator teres is also involved in patterns of spasticity observed in people who had suffered a stroke. Research on treatment efficacy with dry needling is scarce. Objective To determine if a solid filiform needle safely penetrates the pronator teres muscle during the clinical application of dry needling. Design A cadaveric descriptive study. Methods Needle insertion of the pronator teres was conducted in ten cryopreserved forearms with a 30 ×0.32 mm filiform needle. With the forearm supinated, the needle was inserted 3 cm distal to the mid-point between the biceps tendon insertion and the medial epicondyle. The needle was advanced in a cranial and medial direction to a depth clinically judged to be in the pronator teres muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles. Results Accurate needle penetration of the pronator teres was observed in 100% of the specimens (mean needle penetration: 16.7 ± 4.3 mm, 95% confidence interval [CI] 13.6 to 19.7 mm). No neurovascular bundles were pierced in any of the specimen’s forearms. The distances from the tip of the needle to the surrounding neurovascular bundles were 16.4 ± 3.9 mm (95% CI 13.6 to 19.2 mm) to the ulnar nerve (A), 9.0 ± 2.2 mm (95% CI 7.3 to 19.5 mm) to the median nerve (B), and 12.8 ± 4.0 mm (95% CI 10.0 to 15.7 mm) to brachial artery (C). Conclusions The results from this cadaveric study support the assumption that needling of the pronator teres using described anatomical landmarks can be accurately and safely conducted by an experienced clinician.

C0068 Prediction model for minimising the risk of median nerve puncture with dry needling approach at pronator teres muscle

2018 ◽  
Author(s):  
Daniel Muñoz García ◽  
Raúl Ferrer Peña ◽  
Juan Antonio Valera Calero ◽  
Rubén Conde Lima ◽  
Israel del Río Santamaría
Keyword(s):  
Prediction Model ◽  
Median Nerve ◽  
Dry Needling ◽  
Pronator Teres

scholarly journals Is Dry Needling of the Supinator a Safe Procedure? A Potential Treatment for Lateral Epicondylalgia or Radial Tunnel Syndrome. A Cadaveric Study

2021 ◽  
Vol 18 (17) ◽  
pp. 9162
Author(s):  
César Fernández-de-las-Peñas ◽  
Carlos López-de-Celis ◽  
Jacobo Rodríguez-Sanz ◽  
César Hidalgo-García ◽  
Joseph M. Donnelly ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Cadaveric Study ◽  
Safe Procedure ◽  
Dry Needling ◽  
Needle Penetration ◽  
Filiform Needle ◽  
Supinator Muscle ◽  
Lateral Epicondylalgia ◽  
Tunnel Syndrome ◽  
Radial Tunnel Syndrome

The supinator muscle is involved in two pain conditions of the forearm and wrist: lateral epicondylalgia and radial tunnel syndrome. Its close anatomical relationship with the radial nerve at the arcade of Frohse encourages research on dry needling approaches. Our aim was to determine if a solid filiform needle safely penetrates the supinator muscle during the clinical application of dry needling. Needle insertion of the supinator muscle was conducted in ten cryopreserved forearm specimens with a 30 × 0.32 mm filiform needle. With the forearm pronated, the needle was inserted perpendicular into the skin at the dorsal aspect of the forearm at a point located 4cm distal to the lateral epicondyle. The needle was advanced to a depth judged to be in the supinator muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles of the radial nerve. Accurate needle penetration of the supinator muscle was observed in 100% of the forearms (needle penetration:16.4 ± 2.7 mm 95% CI 14.5 mm to 18.3 mm). No neurovascular bundle of the radial nerve was pierced in any of the specimen’s forearms. The distances from the tip of the needle were 7.8 ± 2.9 mm (95% CI 5.7 mm to 9.8 mm) to the deep branch of the radial nerve and 8.6 ± 4.3 mm (95% CI 5.5 mm to 11.7 mm) to the superficial branch of the radial nerve. The results from this cadaveric study support the assumption that needling of the supinator muscle can be accurately and safely conducted by an experienced clinician.

Transient Proximal Median Nerve Entrapment in a Tetraplegic Hand Cyclist Following a 24-Hour Endurance Race

2021 ◽  
Author(s):  
Søren Bruno Elmgreen
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Unusual Case ◽  
Endurance Athlete ◽  
Nerve Entrapment ◽  
Pronator Teres ◽  
Anterior Interosseous Nerve ◽  
Tunnel Syndrome ◽  
Anterior Interosseous Nerve Syndrome

ABSTRACT Median nerve entrapment is a frequent disorder encountered by all clinicians at some point of their career. Affecting the distal median nerve, entrapment occurs most frequently at the level of the wrist resulting in a carpal tunnel syndrome. Median nerve entrapment may also occur proximally giving rise to the much less frequent pronator teres syndrome and even less frequent anterior interosseous nerve syndrome, which owing to the paucity of cases may prove challenging to diagnose. An unusual case of anterior interosseous syndrome precipitated by extraordinary exertion in a tetraplegic endurance athlete is presented with ancillary dynamometric, electrodiagnostic, ultrasonographic, and biochemical findings.

Role of Local Anesthesia During Lumbar Puncture in Neonates

PEDIATRICS ◽  
1993 ◽  
Vol 91 (2) ◽  
pp. 379-382 ◽  
Author(s):  
Joaquim M.B. Pinheiro ◽  
Sue Furdon ◽  
Luis F. Ochoa
Keyword(s):  
Success Rate ◽  
Lumbar Puncture ◽  
Local Anesthesia ◽  
Needle Insertion ◽  
Control Group ◽  
Anatomical Landmarks ◽  
Control Groups ◽  
Lidocaine Injection ◽  
Level Of Training ◽  
Physiologic Responses

Local anesthesia decreases physiologic responses to pain in neonates but has not been used routinely during lumbar punctures in newborns, as it might obscure anatomical landmarks. However, local anesthesia may decrease newborns' struggling during lumbar puncture, thus facilitating the procedure and increasing its success rate. The success rate of lumbar punctures was compared in neonates allocated prospectively to 0.2 to 0.5 mL of 1% lidocaine anesthesia (n = 48) or a control group (n = 52). Newborns were held in a modified lateral recumbent postion (neck not flexed) and their struggling response to the various steps in the lumbar puncture was scored by the holder. The newborns' struggling motion score increased in response to lidocaine injection, but response to the subsequent spinal needle insertion was significantly decreased. Despite this decreased motion, no differences were noted in the number of attempts per lumbar puncture (1.9 ± 0.2 [SEM] in lidocaine and 2.1 ± 0.2 in control groups), rate of lumbar puncture failure (15% in lidocaine and 19% in control groups), or the number of traumatic lumbar punctures (46% in both groups). The success rate of lumbar puncture was not dependent on level of training of physicians performing the procedure. No acute complications, cerebrospinal fluid contamination, or subsequent meningitis was noted in either group. It is concluded that local anesthesia with lidocaine decreases the degree of struggling but does not alter the success rate of lumbar puncture in neonates. The practice of withholding lidocaine anesthesia from neonates undergoing lumbar punctures cannot be justified by arguing that it makes the procedure more difficult to perform.

Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1750-1755 ◽  
Author(s):  
Hesham Elsharkawy ◽  
Wael Saasouh ◽  
Rovnat Babazade ◽  
Loran Mounir Soliman ◽  
Jean-Louis Horn ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Anesthesia ◽  
Needle Insertion ◽  
Adult Patients ◽  
Epidural Needle ◽  
Anatomical Landmarks ◽  
Care Hospital ◽  
Open Prostatectomy ◽  
Ultrasound Guided

Abstract Objective The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view. Design Prospective descriptive trial on a novel approach. Setting Operating room and preoperative holding area at a tertiary care hospital. Subjects Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia. Methods Consented adult patients aged 30–80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2–5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes. Results Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure. Conclusions We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.

Anatomical Landmarks for Femoral Nerve Block: A Comparison of Four Needle Insertion Sites

1999 ◽  
Vol 89 (6) ◽  
pp. 1467 ◽  
Author(s):  
Jerry D. Vloka ◽  
Admir Hadzić ◽  
Leon Drobnik ◽  
April Ernest ◽  
Wojciech Reiss ◽  
...  
Keyword(s):  
Nerve Block ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Needle Insertion ◽  
Anatomical Landmarks ◽  
Insertion Sites

Diagnostic Biopsy of the Pronator Teres and a Motor Branch of the Median Nerve: Indications and Technique

2012 ◽  
Vol 37 (12) ◽  
pp. 2570-2575 ◽  
Author(s):  
Christopher J. Dy ◽  
Dale J. Lange ◽  
Kristofer J. Jones ◽  
Rohit Garg ◽  
Edward F. DiCarlo ◽  
...  
Keyword(s):  
Median Nerve ◽  
Motor Branch ◽  
Pronator Teres ◽  
Diagnostic Biopsy

Neurotization as an alternative for restoring finger and wrist extension

2001 ◽  
Vol 94 (5) ◽  
pp. 795-798 ◽  
Author(s):  
Mehmet Erkan Üstün ◽  
Tunç Cevat Öğün ◽  
Mustafa Büyükmumcu
Keyword(s):  
Median Nerve ◽  
Motor Nerve ◽  
Flexor Digitorum Profundus ◽  
Posterior Interosseous Nerve ◽  
Flexor Pollicis Longus ◽  
Pronator Quadratus ◽  
Content Type ◽  
Pronator Teres ◽  
Flexor Digitorum ◽  
Fine Print

Object. In cases of irreparable injuries to the radial nerve or in cases in which nerves are repaired with little anticipation of restoration of function, tendon transfers are widely used. In this study, the authors searched for a more natural alternative for selectively restoring function, with the aid of a motor nerve transfer. Methods. Ten arms from five cadavers were used in the study. The posterior interosseous nerve and the median nerve together with their motor branches were exposed in the proximal forearm. The possibility of posterior interosseous nerve neurotization via the median nerve through its motor branches leading to the pronator teres, flexor pollicis longus, flexor digitorum profundus, and pronator quadratus muscles was investigated. The lengths of the nerves from points of divergence and their widths were measured using calipers, and the means with standard deviations of all nerves were calculated. Motor branches to the pronator teres, flexor pollicis longus, and pronator quadratus muscles were found to be suitable for neurotization of the posterior interosseous nerve at different levels and in various combinations. The motor nerve extending to the flexor digitorum profundus muscle was too short to use for transfer. Conclusions. These results offer a suitable alternative to tendon transfer for restoring finger and wrist extension in cases of irreversible radial palsy. The second step would be clinical verification in appropriate cases.

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