Recommendation of the Best Site Based on the Distribution Pattern of Extramuscular and Intramusular Nerves for Gluteal Muscle Injection

Abstract

To reveal the extra-and intramuscular nerve distribution patterns of the gluteus maximus, medius, and minimus, and to provide guidance for gluteal muscle injection in order to avoid nerve injury. Ten adult and 10 child cadavers were used. The superior and inferior gluteal nerves innervating the gluteus maximus, medius, and minimus were dissected, exposed, and sutured in-situ on the muscle. The three gluteal muscles were removed, and the distribution patterns of the intramuscular nerves were revealed by modified Sihler's nerve staining. The nerve distribution pattern was returned to the corresponding position in the body, and the patterns in the four quadrants of the buttock were analyzed. There were 3-12 extramuscular nerve branches of the gluteus maximus, medius, and minimus. After entering the muscle, these nerve branches arborized and anastomosed to form an arc-shaped, nerve-dense zone. The nerve distribution was most dense in the inferomedial region of the superolateral quadrant and the inferolateral region of the superomedial quadrant of the buttocks. The nerve distribution was relatively dense in the inferolateral region of the superolateral quadrant, and the medial region of the inferomedial quadrant. An arc-shaped, nerve-sparse zone in the superolateral and superomedial quadrants near the lower iliac crest accounted for about two-fifths of the two quadrants' limits. The arc-shaped, nerve-sparse zone in the superolateral quadrant is the preferred injection site, and the superomedial quadrant near the lower iliac crest is also recommended as a gluteal intramuscular injection region, free from nerve injury.

Intramuscular Neural Distribution of the Gluteus Maximus Muscle: Diagnostic Electromyography and Injective Treatments

“…Only one previous paper confirmed the intramuscular neural distribution pattern in the Gmax. In that study, Junxi Wu et al also visualized the intramuscular neural distribution of Gmax through Sihler's staining, but they based their analysis on the surface structure of the ilium crest and gluteal sulcus [30], so they could not confirm the distribution pattern in the three segments of the Gmax. We first classified the three segments and then identified the nerve distribution pattern within each one.…”

Adverse effects of dorsogluteal intramuscular injection versus ventrogluteal intramuscular injection: A systematic review and meta‐analysis

“…The safety of the ventrogluteal site has also generated doubts. Some studies present an area that is not exempt from risks (Obach et al, 1983; Wu et al, 2020), or other types of adverse effects (Müller‐Vahl, 1985; Wu et al, 2020). This type of injuries is underdocumented, in relation to adverse effects in DS.…”

“…Subsequent medical literature has provide evidence of the safety and efficacy of this site, highlighting its distance from the sciatic nerve (Yalcin et al, 2015), relatively low number of veins present (except some branches of superior gluteal artery or vein; Nakajima et al, 2020) and the reduced thickness of the subcutaneous tissue in comparison with the dorsogluteal site (Arslan & Özden, 2018; Elgellaie et al, 2018; Larkin et al, 2018; Nisbet, 2006). However, some studies present ventrogluteal site as an area that is not exempt from risks (Müller‐Vahl, 1985; Obach et al, 1983; Wu et al, 2020). The safety of the ventrogluteal site has also generated doubts.…”

Magnetic Resonance Imaging Used to Define the Optimum Needle Length in Pigs of Different Ages

“…Some studies exist describing the importance of injection sites and needle length in pigs, i.e., [ 11 , 12 ]. Human and animal research [ 16 , 17 , 18 , 19 , 26 , 27 ] have shown that the optimum injection depth results in less pain and being transferred to animals might result in higher animal welfare. This is of great importance, even if irritating inoculums or vaccines are used, which can result in large-scale tissue alterations [ 1 , 2 , 5 , 6 , 7 , 25 ].…”