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Anatomic surface landmarks to guide injection for posterior interosseous nerve block.

Swapnil D Kachare1, Bradley J Vivace2, Luke T Meredith2

  • 1Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY, USA.

Journal of Plastic Surgery and Hand Surgery
|October 12, 2020
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This study introduces a new anthropometric ratio for precise posterior interosseous nerve (PIN) injections. This method ensures accurate nerve targeting for wrist pain management, improving therapeutic and diagnostic procedures.

Keywords:
Handdenervationinjectioninterosseous nervewrist pain

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Area of Science:

  • Orthopedics
  • Anatomy
  • Pain Management

Background:

  • Accurate posterior interosseous nerve (PIN) injection is crucial for managing wrist pain.
  • Current anatomical studies lack specific injection site guidance based on individual wrist dimensions.

Purpose of the Study:

  • To develop a reproducible anthropometric ratio for predicting a safe and accurate PIN injection site.
  • To utilize external wrist anatomy for precise nerve targeting.

Main Methods:

  • Dissection of 16 fresh frozen cadaver forearms (equal male/female ratio).
  • Acquisition of anthropometric measurements, including wrist circumference at Lister's tubercle.
  • Development of a ratio based on the distance between Lister's tubercle and the ulnar styloid.

Main Results:

  • Male forearms showed a greater mean wrist circumference (17.1 cm) than female forearms (13.5 cm).
  • An injection 1/4 the distance from Lister's tubercle to the ulnar styloid resulted in 100% accurate perineural PIN injection.
  • No intraneural injections were observed using this ratio.

Conclusions:

  • A novel anthropometric ratio can accurately predict distal PIN injection sites.
  • This method is effective across varied cadaveric anatomical proportions.
  • The findings offer a reproducible technique for improved PIN-guided wrist pain treatment.