Ann Rehabil Med.  2020 Dec;44(6):450-458. 10.5535/arm.20035.

Ultrasonographic Analysis of Optimal Needle Placement for Extensor Indicis

• Kim JY
• Seok H
• Kim SH
• Choi YH
• Ahn JY
• Lee SY

• KMID: 2510812
• DOI: http://doi.org/10.5535/arm.20035

Abstract

Objective
To determine the most optimal needle insertion point of extensor indicis (EI) using ultrasound.
Methods
A total 80 forearms of 40 healthy volunteers were recruited. We identified midpoint (MP) of EI using ultrasound and set MP as optimal needle insertion point. The location of MP was suggested using distances from landmarks. Distance from MP to medial border of ulna (MP-X) and to lower margin of ulnar head (MP-Y) were measured. Ratios of MP-X to Forearm circumference (X ratio) and MP-Y to forearm length (Y ratio) were calculated. In cross-sectional view, depth of MP (Dmp), defined as middle value of superficial depth (Ds) and deep depth (Dd) was measured and suggested as proper depth of needle insertion.
Results
Mean MP-X was 1.37±0.14 cm and mean MP-Y was 5.50±0.46 cm. Mean X ratio was 8.10±0.53 and mean Y ratio was 22.15±0.47. Mean Dmp was 7.63±0.96 mm.
Conclusion
We suggested that novel optimal needle insertion point of the EI. It is about 7.6 mm in depth at about 22% of the forearm length proximal from the lower margin of the ulnar head and about 8.1% of the forearm circumference radial from medial border of ulna.

Keyword

Extensor indicis; Injections; Ultrasonography; Electromyography

Figure

• 

  Fig. 1. Parameters measured for midpoint of extensor indicis. (A) Schematic diagram of extensor indicis in forearm. (B) Short-axis ultrasound image of midpoint. MP, midpoint; PO, proximal origin; MTJ, musculotendinous junction; MPY, distance from midpoint to lower margin of ulnar head; MP-X, distance from midpoint to medial border of ulna; Ds, duperficial depth; Dd, deep depth; Dmp, midpoint depth; EI, extensor indicis; EDM, extensor digiti minimi; EDC, extensor digitorum communis; EPL, extensor pollicis longus; EPB, extensor pollicis brevis; ECU, extensor carpi ulnaris.

• 

  Fig. 2. Cross-sectional ultrasound images of three EMG methods: (A) point A, (B) point B, and (C) point C. White arrow indicates needle pathway. EI, extensor indicis; EDM, extensor digiti minimi; EDC, extensor digitorum communis; EPL, extensor pollicis longus; EPB, extensor pollicis brevis.

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