Ann Rehabil Med.  2016 Jun;40(3):457-462. 10.5535/arm.2016.40.3.457.

Optimal Needle Placement for Extensor Hallucis Longus Muscle: A Cadaveric Study

• Cheong IY
• Kim DK
• Oh YJ
• Park BK
• Kim KH
• Kim DH

• KMID: 2327607
• DOI: http://doi.org/10.5535/arm.2016.40.3.457

Abstract

OBJECTIVE
To determine the midpoint (MD) of extensor hallucis longus muscle (EHL) and compare the accuracy of different needle electromyography (EMG) insertion techniques through cadaver dissection.
METHODS
Thirty-eight limbs of 19 cadavers were dissected. The MD of EHL was marked at the middle of the musculotendinous junction and proximal origin of EHL. Three different needle insertion points of EHL were marked following three different textbooks: M1, 3 fingerbreadths above bimalleolar line (BML); M2, junction between the middle and lower third of tibia; M3, 15 cm proximal to the lower border of both malleoli. The distance from BML to MD (BML_MD), and the difference between 3 different points (M1-3) and MD were measured (designated D1, D2, and D3, respectively). The lower leg length (LL) was measured from BML to top of medial condyle of tibia.
RESULTS
The median value of LL was 34.5 cm and BML_MD was 12.0 cm. The percentage of BML_MD to LL was 35.1%. D1, D2, and D3 were 7.0, 0.9, and 3.0 cm, respectively. D2 was the shortest, meaning needle placement following technique by Lee and DeLisa was closest to the actual midpoint of EHL.
CONCLUSION
The MD of EHL is approximately 12 cm above BML, and about distal 35% of lower leg length. Technique that recommends placing the needle at distal two-thirds of the lower leg (M2) is the most accurate method since the point was closest to muscle belly of EHL.

Keyword

Extensor hallucis longus muscle; Cadaver; Electromyography; Needles

MeSH Terms

Cadaver*
Electromyography
Extremities
Leg
Methods
Needles*
Tibia

Figure

• 

  Fig. 1 Needle insertion sites according to three different commonly referred methods: M1, 3 fingerbreadths above the bimalleolar line; M2, junction between the middle and lower third of tibia; M3, 15 cm proximal to the lower border of both malleoli. Bimalleolar line was drawn between lower borders of both malleoli. The distance from bimalleolar line to proximal (BML_PO) and distal origin (BML_DO) of extensor hallucis longus (EHL) was calculated. Musculotendinous junction (MT) and midpoint (MD) of EHL was also marked.

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