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

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.

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Radial Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80152-4 ◽

1995 ◽

Vol 20 (4) ◽

pp. 454-459 ◽

Cited By ~ 52

Author(s):

T. LAWRENCE ◽

P. MOBBS ◽

Y. FORTEMS ◽

J. K. STANLEY

Keyword(s):

Radial Nerve ◽

Tennis Elbow ◽

Free Edge ◽

Wrist Pain ◽

Duration Of Symptoms ◽

Supinator Muscle ◽

Prolonged Duration ◽

Tunnel Syndrome ◽

Manual Tasks ◽

Radial Tunnel Syndrome

Radial tunnel syndrome results from compression of the radial nerve by the free edge of the supinator muscle or closely related structures in the vicinity of the elbow joint. Despite numerous reports on the surgical management of this disorder, it remains largely unrecognized and often neglected. The symptoms of radial tunnel syndrome can resemble those of tennis elbow, chronic wrist pain or tenosynovitis. Reliable objective criteria are not available to differentiate between these pathologies. These difficulties are discussed in relation to 29 patients who underwent 30 primary explorations and proximal decompressions of the radial nerve. Excellent or good results were obtained in 70%, fair results in 13% and poor results in 17% of patients. The results can be satisfactory despite the prolonged duration of symptoms. We believe that a diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. Patients with occupations requiring repetitive manual tasks seem to be particularly at risk of developing radial tunnel syndrome and it is also interesting to note that 66% of patients with on-going medico-legal claims had successful outcomes following surgery.

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Right radial nerve decompression for refractory radial tunnel syndrome

Surgical Neurology International ◽

10.25259/sni_673_2021 ◽

2021 ◽

Vol 12 ◽

pp. 507

Author(s):

Rohin Singh ◽

Yeonsoo Sara Lee ◽

Pelagia E. Kouloumberis ◽

Shelley S. Noland

Keyword(s):

Radial Nerve ◽

Sensory Nerve ◽

Nerve Decompression ◽

Supinator Muscle ◽

History Of ◽

Tunnel Syndrome ◽

The Right ◽

Patient’S History ◽

Extensor Carpi Radialis ◽

Radial Tunnel Syndrome

Background: Radial tunnel syndrome arises due to compression of the radial nerve through the radial tunnel.[1,5] The radial nerve divides into superficial and deep branches in the forearm. The deep branch travels posteriorly through the heads of the supinator where compression commonly occurs.[3,9,7] This syndrome results in pain in the hand and forearm with no motor weakness.[8] This condition can be treated conservatively with splinting and anti-inflammatory medication.[2,4,6] For cases of refractory radial tunnel syndrome, surgical management can be considered. Herein, we have presented a step-by-step video guide on how to perform a radial nerve decompression with a review of the relevant anatomy and surgical considerations. Case Description: A 68-year-old right-handed woman presented to the Mayo Clinic (Scottsdale, AZ) with the right elbow pain which radiated to the forearm causing significant difficulties with daily tasks. She had been dealing with worsening symptoms for 4 months. The patient’s history of gardening and clinical presentation allowed for diagnosis of radial tunnel syndrome. After conservative measures failed and other differential diagnoses were excluded, surgical decompression was recommended to treat her symptoms. The patient’s right arm was marked preoperatively between the brachioradialis and extensor carpi radialis longus (ECRL) muscles. The posterior cutaneous nerve of the forearm was identified which allowed for the determination of the interval between the brachioradialis and ECRL. Separation of the two muscles allowed for the identification of the radial sensory nerve. A nerve stimulator was used to confirm the sensory nature of this nerve. The nerve to the extensor carpi radialis brevis (ECRB) was identified and retracted with a vessel loop. Dorsal to the nerve to the ECRB is the posterior interosseous nerve (PIN), which was identified and retracted with a vessel loop. The fascia of the ECRB was divided both longitudinally and transversely and the supinator below was identified. The supinator muscle was carefully divided to further decompress the PIN. Informed consent for publication of this material was obtained from the patient. Conclusion: The patient tolerated the procedure well and reported significantly reduced pain at 7-month follow-up. To the best of our knowledge, video tutorials on this procedure have not been published. This video can serve as an educational guide for peripheral nerve specialists dealing with similar lesions.

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Morphological Classification of Arch of Frohse and Its Implication in Compression of Deep Branch of Radial Nerve

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/494 ◽

2021 ◽

Vol 10 (31) ◽

pp. 2412-2415

Author(s):

Syed Rehan Hafiz Daimi ◽

Srinivasa Rao Bolla ◽

Moizuddin Jawaduddin Khwaja ◽

Sanket Dadarao Hiware ◽

Shajiya Sarwar Moosa ◽

...

Keyword(s):

Radial Nerve ◽

Inferior Margin ◽

Deep Branch ◽

Supinator Muscle ◽

Essential Components ◽

Arcade Of Frohse ◽

Tunnel Syndrome ◽

Supinator Syndrome ◽

Superior Margin ◽

Radial Tunnel Syndrome

BACKGROUND Arcade of Frohse (AF) is a tendinous superior margin of superficial layer of supinator muscle which was first described by Frohse and Frankel in 1908. Since then it has been studied by many authors and held accountable as one of the essential components for compression of deep branch of radial nerve (DBRN) which leads to radial tunnel syndrome. Considering AF as an important element of compression, we made an attempt to classify it on the basis of its shape and to find out if any particular shape has a predominant role in compression of the nerve. We also observed the structure of superior and inferior margin of the supinator muscle. METHODS This study was conducted among 80 (70 males and 10 females) formalin fixed upper limbs present in the Department of Anatomy. The limbs were maintained in supine with slightly flexed position and dissection was performed to expose the supinator muscle. The proximal and distal borders of supinator muscles were examined meticulously with the help of magnified lens. The morphometric measurements were taken with the help of a digital caliper. RESULTS The FA is classified into four categories as loop, high arc, low arch and linear shaped. The most frequent shape observed was arch shaped (high and low arch) about 66%, followed by loop shaped (30%) and least was linear shaped (2.5%). On the basis of structure, the proximal and distal margin of supinator muscle was reported to be tendinous in majority of the cases. The distance of the AF from the fixed reproducible anatomical landmark like inter epicondylar line (IEL) was measured and the average distance found was 3.36 cm. CONCLUSIONS Knowledge of different shapes would aid surgeons and radiologists for better approach towards diagnosis and management of supinator syndrome. The morphometric finding can be useful for surgeons to locate the superior margin of supinator (AF) in surgical procedures for decompression of DBRN in supinator syndrome. KEY WORDS Arcade of Frohse, Inter Epicondylar Line, Supinator Muscle, Deep Branch of Radial Nerve and Radial Tunnel Syndrome

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Effect of dry needling on radial tunnel syndrome: A case report

Physiotherapy Theory and Practice ◽

10.1080/09593985.2018.1443357 ◽

2018 ◽

Vol 35 (4) ◽

pp. 373-382 ◽

Cited By ~ 2

Author(s):

Sudarshan Anandkumar

Keyword(s):

Case Report ◽

Dry Needling ◽

Tunnel Syndrome ◽

Radial Tunnel Syndrome

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A New Clinical Test for Radial Tunnel Syndrome—The Rule-of-Nine Test: A Cadaveric Study

Journal of Orthopaedic Surgery ◽

10.1177/230949900401200115 ◽

2004 ◽

Vol 12 (1) ◽

pp. 83-86 ◽

Cited By ~ 22

Author(s):

YC Loh ◽

WL Lam ◽

JK Stanley ◽

RW Soames

Keyword(s):

Cadaveric Study ◽

Clinical Test ◽

Tunnel Syndrome ◽

Radial Tunnel Syndrome

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

Pain Medicine ◽

10.1093/pm/pnab274 ◽

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.

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Radial Tunnel Syndrome: Emphasis on the Superficial Branch of the Radial Nerve

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408099832 ◽

2009 ◽

Vol 34 (3) ◽

pp. 343-347 ◽

Cited By ~ 19

Author(s):

M. A. J. BOLSTER ◽

X. R. BAKKER

Keyword(s):

Surgical Technique ◽

Radial Nerve ◽

Combined Treatment ◽

Surgical Decompression ◽

Posterior Interosseous Nerve ◽

Success Rates ◽

Anatomical Basis ◽

Superficial Branch ◽

Tunnel Syndrome ◽

Radial Tunnel Syndrome

Reported success rates for decompressing the radial nerve in patients with radial tunnel syndrome vary between 10 and 95%. The combined treatment, releasing both the posterior interosseous nerve and the superficial branch of the radial nerve, has been described only three times, but seems to show more consistent success rates compared with releasing the posterior interosseous nerve alone. We present the results of decompressing the superficial branch of the radial nerve only, the anatomical basis for this approach and a description of the surgical technique. Our results are comparable to the results of the combined treatment. Eleven of 12 patients were satisfied with the results of the operation. This study indicates that pain in patients with radial tunnel syndrome may be treated successfully by surgical decompression of the superficial branch of the radial nerve.

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