Is Dry Needling of the Supinator a Safe Procedure? A Potential Treatment for Lateral Epicondylalgia or Radial Tunnel Syndrome. A Cadaveric Study

Abstract

The supinator muscle is involved in two pain conditions of the forearm and wrist: lateral epicondylalgia and radial tunnel syndrome. Its close anatomical relationship with the radial nerve at the arcade of Frohse encourages research on dry needling approaches. Our aim was to determine if a solid filiform needle safely penetrates the supinator muscle during the clinical application of dry needling. Needle insertion of the supinator muscle was conducted in ten cryopreserved forearm specimens with a 30 × 0.32 mm filiform needle. With the forearm pronated, the needle was inserted perpendicular into the skin at the dorsal aspect of the forearm at a point located 4cm distal to the lateral epicondyle. The needle was advanced to a depth judged to be in the supinator muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles of the radial nerve. Accurate needle penetration of the supinator muscle was observed in 100% of the forearms (needle penetration:16.4 ± 2.7 mm 95% CI 14.5 mm to 18.3 mm). No neurovascular bundle of the radial nerve was pierced in any of the specimen’s forearms. The distances from the tip of the needle were 7.8 ± 2.9 mm (95% CI 5.7 mm to 9.8 mm) to the deep branch of the radial nerve and 8.6 ± 4.3 mm (95% CI 5.5 mm to 11.7 mm) to the superficial branch of the radial nerve. The results from this cadaveric study support the assumption that needling of the supinator muscle can be accurately and safely conducted by an experienced clinician.

Cadaveric and Ultrasound Validation of Percutaneous Electrolysis Approaches at the Arcade of Frohse: A Potential Treatment for Radial Tunnel Syndrome

“…The distances observed in the current study during the US-guided intervention were higher than those reported in this previous study [ 16 ], supporting the potential improved safety of the procedure if US-guided. Additionally, the cadaveric study also revealed that the tip of the needle reached the radius bone in 80% of the specimens [ 16 ]. The application of US imaging allowed hitting the bone with the needle to be avoided in the current study.…”

“…This study found that needling insertion of the supinator muscle at Frohse arcade with both approaches provided enough space to avoid penetration of the neurovascular bundle, particularly if the procedure was US-guided. A recent cadaveric study reported distances of 8 mm from the tip of the needle to the different branches of the radial nerve during the application of dry needling with the forearm in pronation [ 16 ]. The distances observed in the current study during the US-guided intervention were higher than those reported in this previous study [ 16 ], supporting the potential improved safety of the procedure if US-guided.…”

“…A recent cadaveric study reported distances of 8 mm from the tip of the needle to the different branches of the radial nerve during the application of dry needling with the forearm in pronation [ 16 ]. The distances observed in the current study during the US-guided intervention were higher than those reported in this previous study [ 16 ], supporting the potential improved safety of the procedure if US-guided. Additionally, the cadaveric study also revealed that the tip of the needle reached the radius bone in 80% of the specimens [ 16 ].…”