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

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.

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INNERVATION PATTERN OF PRONATOR TERES MUSCLE AND ITS RELATION TO MEDIAN NERVE: A CADAVERIC STUDY

International Journal of Anatomy and Research ◽

10.16965/ijar.2017.258 ◽

2017 ◽

Vol 5 (3.1) ◽

pp. 4092-4095

Author(s):

Channa basanagouda ◽

◽

Manjunath Halagatti ◽

Keyword(s):

Median Nerve ◽

Cadaveric Study ◽

Innervation Pattern ◽

Pronator Teres

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

Military Medicine ◽

10.1093/milmed/usab226 ◽

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.

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

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2012.09.014 ◽

2012 ◽

Vol 37 (12) ◽

pp. 2570-2575 ◽

Cited By ~ 6

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

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Neurotization as an alternative for restoring finger and wrist extension

Journal of Neurosurgery ◽

10.3171/jns.2001.94.5.0795 ◽

2001 ◽

Vol 94 (5) ◽

pp. 795-798 ◽

Cited By ~ 18

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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Uncommon course of the ulnar artery through the pronator teres muscle

Journal of Nepal Medical Association ◽

10.31729/jnma.2722 ◽

1970 ◽

Vol 52 (195) ◽

pp. 946-948

Author(s):

Katerina Vymazalová ◽

Lenka Vargová ◽

Marek Joukal

Keyword(s):

Median Nerve ◽

Anatomical Variation ◽

Ulnar Artery ◽

Predisposing Factor ◽

Anatomical Structures ◽

Pronator Teres ◽

Flexor Carpi Ulnaris ◽

Cubital Fossa ◽

The Right ◽

Flexor Digitorum

In this paper, we describe a very rare variant in the course of the ulnar artery that we encountered in dissecting the right upper limb of a 74-year-old man. The ulnar artery arose standardly from the brachial artery in the cubital fossa. However, its ensuing course differed from the norm. The artery entered together with the ulnar vein and median nerve into the pronator canal (between the humeral and ulnar heads of the pronator teres). Further, the ulnar artery descended classically to the ulnar side of the forearm between the flexor carpi ulnaris and flexor digitorum superficialis. Knowledge of this variation in the course of the ulnar artery may have significance in clinical practice because accumulation of anatomical structures in the pronator canal could be a predisposing factor for the compression of nerve or blood vessels. Keywords: anatomical variation; median nerve; pronator canal; pronator teres muscle; ulnar artery.

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