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Optimal Needle Placement for Extensor Hallucis Longus Muscle: A Cadaveric Study.

In Yae Cheong1, Do Kyun Kim1, Ye Jeong Oh2

  • 1Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.

Annals of Rehabilitation Medicine
|July 23, 2016
PubMed
Summary

The midpoint of the extensor hallucis longus muscle is about 12 cm above the bimalleolar line. A technique placing the needle in the distal two-thirds of the lower leg is most accurate for electromyography insertion.

Keywords:
CadaverElectromyographyExtensor hallucis longus muscleNeedles

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Area of Science:

  • Anatomy
  • Electromyography
  • Musculoskeletal System

Background:

  • Accurate needle placement is crucial for reliable electromyography (EMG) of the extensor hallucis longus (EHL) muscle.
  • Existing anatomical landmarks and textbook techniques for EHL EMG insertion vary.

Purpose of the Study:

  • To determine the precise midpoint (MD) of the EHL muscle.
  • To compare the accuracy of three different needle EMG insertion techniques using cadaver dissection.

Main Methods:

  • Dissection of 38 lower limbs from 19 cadavers.
  • Marking the EHL midpoint (MD) and three textbook-defined insertion points (M1, M2, M3).
  • Measuring distances from the bimalleolar line (BML) to the MD and to each insertion point.

Main Results:

  • The EHL midpoint (MD) was located approximately 12 cm above the BML, representing 35.1% of the lower leg length.
  • Needle insertion technique M2 (distal two-thirds of the lower leg) showed the smallest deviation (0.9 cm) from the actual EHL midpoint.
  • Techniques M1 and M3 demonstrated larger deviations of 7.0 cm and 3.0 cm, respectively.

Conclusions:

  • The EHL muscle midpoint is consistently located around 12 cm proximal to the bimalleolar line.
  • The insertion technique M2, targeting the distal two-thirds of the lower leg, is the most accurate for EHL EMG needle placement.