Ann Rehabil Med.  2013 Apr;37(2):215-220. 10.5535/arm.2013.37.2.215.

Ultrasonographic Evaluation of Needle Insertion Site for the Flexor Pollicis Longus

• Lee SM
• Kim K
• Lee SM
• Lee HS

• KMID: 2165773
• DOI: http://doi.org/10.5535/arm.2013.37.2.215

Abstract

OBJECTIVE
To establish the safest approach to needle electrode insertion into the flexor pollicis longus (FPL) regarding possible needle injury to the superficial radial nerve (SRN) or radial artery by ultrasonography.
METHODS
We evaluated 54 forearms of 27 healthy subjects. Three levels were defined in the forearm. Level 1 is the junction of the middle and distal third of the forearm, level 3 is the midpoint of forearm length, and level 2 is the midpoint between two levels. At each level, the distance between the most prominent point of the radius and the SRN (region A), the distance between the SRN and the radial artery (region B), and the depth from the skin surface to the FPL were measured.
RESULTS
The distance of region A was 1.20+/-0.41 cm in level 1, 1.62+/-0.45 cm in level 2, and 1.95+/-0.49 cm in level 3. The distance of region B was 1.02+/-0.29 cm in level 1, 0.61+/-0.24 cm in level 2, and 0.37+/-0.19 cm in level 3. The depth from the skin surface to the FPL was 0.92+/-0.20 cm in level 1, 1.14+/-0.26 cm in level 2, and 1.45+/-0.29 cm in level 3.
CONCLUSION
The safest needle insertion point to the FPL is the middle of the forearm within approximately 0.8 cm from the most prominent point of the radius. We recommend that the needle is inserted at the above point perpendicular to the skin surface until the needle meets the FPL at a depth of approximately 1.45 cm from the skin surface.

Keyword

Electromyography; Ultrasonography; Forearm; Needlestick

MeSH Terms

Electrodes
Electromyography
Forearm
Needles
Needlestick Injuries
Radial Artery
Radial Nerve
Radius
Skin

Figure

• 

  Fig. 1 Ultrasonography of the forearm in water bath with the transducer placed on the three levels of the forearm in transverse plane. Level 1, the junction of middle and distal third of the forearm; level 2, the midpoint of level 1 and level 3; level 3, the midpoint of the forearm.

• 

  Fig. 2 Transverse view of ultrasonographic images of the forearm at the junction of middle and distal third of the foreram (level 1; A), at the midpoint between level 1 and level 3 (level 2; B), and at the midpoint of the forearm (level 3; C). a, most prominent point of the radius; b, midpoint of the superficial radial nerve; c, midpoint of the radial artery; Sa, skin surface point from a; Sb, skin surface point from b; Sc, skin surface point from c; A, distance between Sa and Sb; B, distance between Sb and Sc; D, depth from the skin surface to the FPL; RA, radial artery; SRN, superficial radial nerve; R, radius; FPL, flexor pollicis longus.

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