Ann Rehabil Med.  2021 Feb;45(1):42-48. 10.5535/arm.20092.

Which Approach Is Most Optimal for Needle Electromyographic Examination of the Biceps Femoris Short Head: Medial or Lateral?

• Park JH
• Rhyu IJ
• Lim HK
• Cha JH
• Shin GJ
• Rhim HC
• Kim DH

• KMID: 2513229
• DOI: http://doi.org/10.5535/arm.20092

Abstract

Objective
To investigate the anatomical characteristics of the biceps femoris short head (BS) and determine the optimal needle placement for BS examination.
Methods
Twenty-one lower limbs were dissected. The distances from the medial and lateral margins of the biceps femoris long head (BL) tendon to the common fibular nerve (CFN) (M_CFN_VD and L_CFN_VD, respectively) and the distance from the lateral margin of the BL tendon to the lateral margin of the BS (L_BS_HD) were measured 5 cm proximal to the tip of the fibular head (P1), four fingerbreadths proximal to the tip of the fibular head (P2), and at the upper apex of the popliteal fossa (P3).
Results
The BS was located lateral to the BL tendon. The CFN was located along the medial margin of the BL tendon. The median values were 2.0 (P1), 3.0 (P2), and 0 mm (P3) for M_CFN_VD; and 17.4 (P1), 20.2 (P2), and 21.8 mm (P3) for L_CFN_VD; and 8.1 (P1), 8.8 (P2), and 13.0 mm (P3) for L_BS_VD.
Conclusion
The lateral approach to the BL tendon was safer than the medial approach for examining the BS. Amore proximal insertion site around the upper apex of the popliteal fossa was more accurate than the distal insertion site. In this study, we propose a safer and more accurate approach for electromyography of the BS.

Keyword

Hamstring muscles, Hamstring tendons, Electromyography, Fibular nerve, Cadaver

Figure

• 

  Fig. 1. Dissected cadaver indicating the anatomical marking sites and needle insertion levels according to the three commonly referred methods for electromyography of the biceps femoris short head muscle (BS). The common fibular nerve (CFN) divided from the sciatic nerve follows closely along the medial margin of the biceps femoris long head (BL) tendon. The BS is located laterally along the lateral margin of the BL tendon. TN, tibial nerve; IT, ischial tuberosity; UO, upper origin of the BS; FH, fibular head; P1, 5 cm proximal to the tip of the FH; P2, four fingerbreadths proximal to the FH (approximately 7 cm in this study); P3, the upper apex of the popliteal fossa.

• 

  Fig. 2. Box-and-whisker plots of the vertical distance from the lateral margin of the biceps femoris long head (BL) tendon to the lateral margin of the biceps femoris short head (BS) (L_BS_VD), and of the vertical distances from the lateral and medial margins of the BL tendon to the common fibular nerve (CFN) (L_CFN_VD and M_CFN_VD, respectively) at the P1, P2, and P3 levels in all cases (21 limbs). Distances were recorded as a negative value if the CFN was located lateral to the lateral or medial margin of the BL tendon, or if the lateral margin of the BS was located lateral to the lateral margin of the BL tendon. P1 level, 5 cm proximal to the tip of the fibular head; P2 level, 4 fingerbreadths proximal to the fibular head (approximately 7 cm in this study); P3 level, upper apex of the popliteal fossa.

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