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Comparison of the Electromyography Needle Insertion Sites for the Pronator Teres Muscle

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Objective: To compare electromyography needle insertion sites to the pronator teres and identify the safe needle location to minimize neurovascular injury. Methods: Twenty-nine upper limbs of 19 adult cadavers were dissected. The total length of pronator teres (PT) and the angle between elbow crease and the lateral border of pronator teres were measured. Needle insertion sites were at 2.5 cm distally from the cross-point of elbow crease and pronator teres (M1), at two finger breadths distal to the midpoint of a line connecting the medial epicondyle and biceps tendon (M2), and 5cm distal to the midpoint of elbow crease (M3). Distances from the humeral origin of the pronator teres to M1, M2, and M3, and distances from the humeral origin of the pronator teres to brachial artery and median nerve were measured. Results: The mean length of the PT was 9.2±1.8 cm and the angle between elbow crease and the lateral border of pronator teres was 63.5±7.7 degrees. The distances from the origin of pronator teres to M1,M2, M3, brachial artery, and median nerve were 3.2±0.7 cm, 3.6±0.5 cm, 5.9±0.7 cm, 4.4±0.6 cm, and 3.6±0.6 cm, respectively. Conclusion: Among the three needle insertion sites, M1 seems to be a safe method to evaluate pronator teres with needle. However, the tip of needle must be directed towards the origin of the pronator teres to avoid incidental injury of neurovascular bundle.

Abstract

Objective: To compare electromyography needle insertion sites to the pronator teres and identify the safe needle location to minimize neurovascular injury. Methods: Twenty-nine upper limbs of 19 adult cadavers were dissected. The total length of pronator teres (PT) and the angle between elbow crease and the lateral border of pronator teres were measured. Needle insertion sites were at 2.5 cm distally from the cross-point of elbow crease and pronator teres (M1), at two finger breadths distal to the midpoint of a line connecting the medial epicondyle and biceps tendon (M2), and 5cm distal to the midpoint of elbow crease (M3). Distances from the humeral origin of the pronator teres to M1, M2, and M3, and distances from the humeral origin of the pronator teres to brachial artery and median nerve were measured. Results: The mean length of the PT was 9.2±1.8 cm and the angle between elbow crease and the lateral border of pronator teres was 63.5±7.7 degrees. The distances from the origin of pronator teres to M1,M2, M3, brachial artery, and median nerve were 3.2±0.7 cm, 3.6±0.5 cm, 5.9±0.7 cm, 4.4±0.6 cm, and 3.6±0.6 cm, respectively. Conclusion: Among the three needle insertion sites, M1 seems to be a safe method to evaluate pronator teres with needle. However, the tip of needle must be directed towards the origin of the pronator teres to avoid incidental injury of neurovascular bundle.

참고문헌 (12)

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  6. Johnson RJ, "Electrodiagnosis: An anatomical and clinical approach. 1st ed", pp.145~ (1986), Lippincott Williams and Wilkins
  7. Perotto AO, "Anatomical guide for the electromyographer. 3rd ed", pp.69~71 (1994), Thomas
  8. Jenkins DB, "Hollinshead's functional anatomy of the limbs and back. 8th ed", pp.144~157 (2002), Saunders
  9. Ashworth NL, "Anterior interosseous nerve syndrome presenting with pronator teres weakness: a case report", Muscle & Nerve, 20, pp.1591~1594 (1997)
  10. Gessini L, "Entrapment neuropathies of the median nerve at and above the elbow", Surg Neurol, 19, pp.112~116 (1983)
  11. Canovas F, "Biometry of the muscular branches of the median nerve to the forearm", Clin Anat, 11, pp.239~245 (1998)
  12. Rodriguez-Niedenfuhr M, "Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature", J Anat, 199, pp.547~566 (2001)

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