Needle electrode insertion into the tibialis posterior: a comparison of the anterior and posterior approaches

Yang S-N, Lee S-H, Kwon H-K. Needle electrode insertion into the tibialis posterior: a comparison of the anterior and posterior approaches.

Objectives

To analyze and compare the safety of the anterior and posterior approaches for needle electrode placement and to examine the method for inserting the needle electrode using the anterior approach.

Design

Cross-sectional study.

Setting

University hospital.

Participants

Lower-extremity radiographs and magnetic resonance images of 22 patients (13 men, 9 women).

Interventions

Not applicable.

Main Outcome Measure

Measurement of lower-extremity radiographs and magnetic resonance imaging.

Results

The anterior approach offers the advantage of a larger safe window for needle insertion into the upper third of the leg than the posterior approach. No significant differences were observed between the anterior and posterior approaches in terms of safety of needle insertion into the midpoint. The safe zone of the overlying skin for needle insertion was found to be approximately 40% to 80% of the width of the tibia away from the lateral margin of the tibia shaft on the upper third of the leg and 32% to 58% of the width of the tibia at the midpoint of the leg in the anterior approach.

Conclusions

The method suggested in this article can be used for needle electromyography and deserves more widespread use in clinical practice.     

Ultrasonographic evaluation of needle electromyography insertion into the tibialis posterior using a posterior approach

Won SJ, Kim JY, Yoon JS, Kim SJ. Ultrasonographic evaluation of needle electromyography insertion into the tibialis posterior using a posterior approach.

Objective

To estimate the safety window for needle insertion in the posterior approach to the tibialis posterior by ultrasonography, particularly in a clinical setting.

Design

Cross-sectional study.

Setting

University hospital.

Participants

Healthy volunteers (108 legs, from 22 men and 32 women).

Interventions

Not applicable.

Main Outcome Measures

Distance between the tibia and neurovascular bundles in the posterior aspect of the tibia on a transverse ultrasonographic scan.

Results

The safety window at the midpoint was significantly larger than the upper third (0.62–2.16cm, average 1.47±0.38cm vs 0.51–1.62cm, average 1.16±0.31cm). The depth at the midpoint was significantly more shallow than the upper third (1.57–3.16cm, average 2.31±0.34cm vs 1.76–3.66cm, average 2.52±0.38cm). Body weight, height, tibial length, and leg circumference showed positive correlation with the safety window at both points.

Conclusions

The midpoint may be more favorable than the upper third for needle insertion to the tibialis posterior with a posterior approach.     

Electromyographic value of the tibialis posterior muscle.

Differentiation between peroneal palsy and L5 radiculopathy poses a diagnostic challenge. However, clinical weakness of the tibialis posterior muscle indicates that the involvement must lie outside the peroneal territory, potentially at a radicular level. Electromyographically this muscle should provide similar information but it has been relatively ignored, possibly for reasons of presumed inaccessibility. A retrospective study was undertaken to delineate the potential electrical discriminatory value of this muscle. Patients selected were those with clinical evidence of lower extremity neurogenic dysfunction in whom needle electrode examination had been performed on the tibialis posterior as well as other posterior and anterior compartment musculature. The parameters measured were the presence of abnormal spontaneous activity suggestive of denervation plus neurogenic motor unit alterations. Abnormalities were detected in the tibialis posterior which were reflected equally in the anterior but not posterior compartment muscles, indicating a shared L5 radicular innervation. Thus this muscle represents a useful source of electrical information assisting in the differentiation between peroneal and radicular dysfunction.     

Needle electrode connectors for EMG testing: a new technique

Subcutaneous needles as reference and ground electrodes in electromyography are clinically and practically more advantageous than surface electrodes. A functional and inexpensive set of electromyography needle electrode connectors is easily fabricated. The necessary components are readily available at approximately $4.00 and manufacture is simple. The life span of each electrode set is more than two years with standard care.     

A new approach for posterior mediastinal tumors: thoracoscopic resection in the prone position

Video-assisted thoracoscopic surgery in the lateral position has been the standard surgical approach for posterior mediastinal tumors. Herein, we report the successful thoracoscopic resection of a posterior mediastinal tumor with the patient in the prone position. The patient was a 62-year-old man with a posterior mediastinal mass. We were able to completely extirpate the posterior mediastinal tumor by means of thoracoscopic resection, with the patient in the prone position, much in the manner of solo surgery. The prone position has the potential to become the standard thoracoscopic surgical approach for posterior mediastinal tumors because it provides excellent exposure of the posterior mediastinum.     

A new multidisciplinary approach to integrating best evidence into musculoskeletal practice

RATIONALE: The effective integration of research evidence into everyday clinical practice continues to be an important challenge. AIMS: The group aimed to answer locally relevant clinical question and produce recommendations for practice based on the best available evidence. METHODS: Through a new initiative, a multidisciplinary group with a specific interest in musculoskeletal disease has been established in order to help address this problem. The group consists of clinical and academic professionals including physiotherapists, occupational therapists, nurses, clinical researchers and information technology librarians representing the health economy. RESULTS: Results from the group's activities are shared locally through presentations and clinical algorithms and nationally through conference presentations and the National Electronic Library for Health. CONCLUSION: As well as clinical recommendations, other benefits of the group have been improved networking, enhanced continual professional development and identifying areas in need of further research.     

The posterior thoracic approach in echocardiography.

Echocardiograms were recorded using a left posterior thoracic approach in 17 patients with left pleural effusion. Comparison of these records with those obtained using the conventional technique in the same patients revealed that the left posterior thoracic approach yielded records of adequate quality in all patients. The mitral valve, the left ventricle, and the posterior pericardium were well defined. In 10 patients in whom pericardial effusion was also p;esent, the posterior approach facilitated clear separation of the pleural and pericardial effusions. A major limitation of the posterior technique appears to be inability to record the aortic root, the aortic valve, and the left atrium.     

An "antibody electrode," preliminary report on a new approach in enzyme immunoassay.

We report preliminary experiments on a new, sensitive, and reliable procedure for enzyme immunoassay of various antigens in biological fluids. The method, developed from the biological model "hepatitis B surface-antigen/antibodies," is less time consuming than most immunochemical techniques and eliminates many inconveniences arising from use of isotopes. We use a solid-phase "sandwich" procedure, the antibodies being immobilized on gelatin membranes, and determine antigen concentration with the help of an iodide-sensitive electrode modified by fixing the active membrane onto the crystal sensor. We have established the analytical criteria of the method and compared it with the solid-phase radioimmunoassay for the surface antigen in dilution series. One-tenth microgram of antigen per liter can be reproducibly detected with our method. Use of antibody electrode should easily be extended to assay of other antigens and haptens that usually are determined by radioimmunoassay.     

Ultrasound-guided lateral approach for needle insertion into the subscapularis for treatment of spasticity

Rha D-w, Han S-H, Kim H-J, Won S-Y, Lee SC. Ultrasound-guided lateral approach for needle insertion into the subscapularis for treatment of spasticity.ObjectiveTo evaluate the safety and accuracy of ultrasound (US)-guided needle insertion into the subscapularis using fresh cadavers.DesignA needle was inserted into the subscapularis of adult human cadavers under US guidance using a lateral approach from the posterior axillary fold. An anatomist dissected the cadavers to evaluate the effectiveness of this injection method.SettingUniversity dissecting room.ParticipantsFresh cadavers (N=5).InterventionsUS-guided dye injections targeting the motor points of the subscapularis.Main Outcome MeasureAccuracy of the injections and prevalence of complications. The presence of dye within 1.0cm of the motor points was defined as reaching the target. The injection procedure was considered a success if two-thirds of the injected dye reached the target.ResultsWe did not identify any neurovascular structures at risk of injury in the injection route. All subscapularis muscles were injected successfully using the US-guided lateral approach.ConclusionsUS-guided needle insertion into the subscapularis using this lateral approach was accurate and had the minimal risk of neurovascular or lung injuries.