The accuracy of needle placement in lower-limb muscles: a blinded study11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

Haig, Andrew J.; Goodmurphy, Craig; Harris, Albert R.; Ruiz, Alejandro Perez; Etemad, Jeffery

doi:10.1016/s0003-9993(03)00014-5

Cited by 45 publications

(15 citation statements)

References 10 publications

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“…In addition, in some cases, the insertion of needles may unintentionally damage important structures. For example, in a study on cadavers, Haig et al (2003) showed that when a needle was inserted into a muscle according to standard clinical procedures, the tip was in the intended location in only 45 per cent of the cases and within 5 mm of important structures, such as nerves, arteries or veins, in 17 per cent of the cases.…”

Section: Electrodes For Emg Signal Detectionmentioning

confidence: 99%

Analysis of intramuscular electromyogram signals

Merletti

Farina

2008

Phil. Trans. R. Soc. A.

121

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Intramuscular electromyographic (EMG) signals are detected with needles or wires inserted into muscles. With respect to non-invasive techniques, intramuscular electromyography has high selectivity for individual motor unit action potentials and is thus used to measure motor unit activity. Decomposition of intramuscular signals into individual motor unit action potentials consists in detection and classification, usually followed by separation of superimposed action potentials. Although intramuscular EMG signal decomposition is the primary tool for physiological investigations of motor unit properties, it is rarely applied in clinical routine, because of the need for human interaction and the difficulty in interpreting the quantitative data provided by EMG signal decomposition to support clinical decisions. The current clinical use of intramuscular EMG signals relates to the diagnosis of myopathies, of diseases of the α-motor neuron and of the neuromuscular junction through the analysis of the interference signal or of the shape of some motor unit action potentials, usually without a full decomposition of the signal.

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Section: Electrodes For Emg Signal Detectionmentioning

confidence: 99%

Analysis of intramuscular electromyogram signals

Merletti

Farina

2008

Phil. Trans. R. Soc. A.

121

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“…Prior research has indicated the potential for incorrect needle placement without imaging guidance. In a study by Haig et al [ 2 ], the accuracy rates of blind needle placement into the long and short heads of the biceps femoris, tibialis posterior, and peroneus longus were 70%, 30%, 10%, and 50%, respectively. Boon et al [ 1 ] evaluated the same muscles with accuracy rates of 25%, 100%, 50%, and 75%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, it is impossible to accurately place a needle in some situations, such as when anatomical landmarks disappear due to surgery or trauma or when auditory feedback is unavailable due to the absence of voluntary muscle contraction in an unconscious patient [ 1 ]. Inaccurate needle placement can cause poor diagnostic utility of EMG and damage nerves, vessels, and organs [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…The use of ultrasonography (US) has been increasing because of its advantages, such as no radiation exposure, quick scan time, and utility for observing soft tissue [ 3 ]. Previous studies have reported that the accuracy rate of needle EMG using anatomical landmarks is low [ 1 , 2 ]. Therefore, needle EMG using US has been studied recently [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of Needle Placement in Cadavers: Non-Guided Versus Ultrasound-Guided

et al. 2015

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ObjectiveTo compare the accuracy rates of non-guided vs. ultrasound-guided needle placement in four lower limb muscles (tibialis posterior, peroneus longus, and short and long heads of the biceps femoris).MethodsTwo electromyographers examined the four muscles in each of eight lower limbs from four fresh frozen cadavers. Each electromyographer injected an assigned dye into each targeted muscle in a lower limb twice (once without guidance, another under ultrasound guidance). Therefore, four injections were done in each muscle of one lower limb. All injections were performed by two electromyographers using 18 gauge 1.5 inch or 24 gauge 2.4 inch needles to place 0.5 mL of colored acryl solution into the target muscles. The third person was blinded to the injection technique and dissected the lower limbs and determined injection accuracy.ResultsA 71.9% accuracy rate was achieved by blind needle placement vs. 96.9% accuracy with ultrasound-guided needle placement (p=0.001). Blind needle placement accuracy ranged from 50% to 93.8%.ConclusionUltrasound guidance produced superior accuracy compared with that of blind needle placement in most muscles. Clinicians should consider ultrasound guidance to optimize needle placement in these muscles, particularly the tibialis posterior.

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“…Location of the needle after manual intramuscular needle placement can be checked by passive stretching and relaxing of the target muscle (PSRM) [16-21], palpation [18,21] and imaging and guiding tools: electrical stimulation (ES) [16,18,21-23], ultrasound [19-21,23,24], computer tomography, X-ray [14,16,17,19,22,24,25] and electromyography [17,19,22]. …”

Section: Introductionmentioning

confidence: 99%

Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by means of electrical stimulation

2013

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BackgroundIntramuscular injection of botulinum toxin type-A given by manual intramuscular needle placement in the lower extremity under general anaesthesia is an established treatment and standard of care in managing spasticity in children with spastic cerebral palsy. Optimal needle placement is essential. However, reports of injection and verification techniques used in previous studies have been partly incomplete and there are methodological shortcomings. This paper describes a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target muscle for each individual muscle injection location in the lower extremity during botulinum toxin type-A treatment under general anaesthesia in children with spastic cerebral palsy. It explains the design of a study to verify this protocol, which consists of an injection technique combined with a needle localizing technique, as by means of electrical stimulation to determine its precision.MethodsSetting: University Medical Centre, Department of Paediatric Rehabilitation Medicine, the Netherlands.Design: prospective observational study.Participants: children with spastic cerebral palsy, aged 4 to 18 years, receiving regular botulinum toxin type-A treatment under general anaesthesia to improve their mobility, are recruited from the Department of Paediatric Rehabilitation Medicine at VU University Medical Centre, Amsterdam, the Netherlands.Method: a detailed protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target muscle has been developed for each individual muscle injection location of the adductor brevis muscle, adductor longus muscle, gracilis muscle, semimembranosus muscle, semitendinosus muscle, biceps femoris muscle, rectus femoris muscle, gastrocnemius lateralis muscle, gastrocnemius medialis muscle and soleus muscle. This protocol will be verified as by means of electrical stimulation.Technical details: 25 mm or 50 mm Stimuplex-needle and a Stimuplex-HNS-12 electrical stimulator will be used.DiscussionBotulinum toxin type-A injected in the intended muscle is expected to yield the greatest effect in terms of activities. Protocols for manual intramuscular needle placement should be described in detail and verified to determine its precision. Detailed and verified protocols are essential to be able to interpret the results of botulinum toxin type-A treatment studies.

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The accuracy of needle placement in lower-limb muscles: a blinded study11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

Cited by 45 publications

References 10 publications

Analysis of intramuscular electromyogram signals

Analysis of intramuscular electromyogram signals

Accuracy of Needle Placement in Cadavers: Non-Guided Versus Ultrasound-Guided

Study protocol: precision of a protocol for manual intramuscular needle placement checked by passive stretching and relaxing of the target muscle in the lower extremity during BTX-A treatment in children with spastic cerebral palsy, as verified by means of electrical stimulation

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