Dorsal dry needling to the pronator quadratus muscle is a safe and valid technique: A cadaveric study

The pronator quadratus (PQ) muscle is an important stabilizer of the distal radio-ulnar joint and its pain referral pattern can mimic median or ulnar neuropathy. Research on treatment safety and efficacy with dry needling is scarce.

To determine if a solid filiform needle accurately and safely penetrates the PQ during simulated clinical application of dry needling.

A cadaveric descriptive study was conducted. Needling insertion of PQ was performed in 10 cryopreserved forearms with a 30*0.32 mm solid filiform needle. With the forearm pronated, the needle was inserted 3 cm proximal to the ulnar styloid in an anterior direction toward the muscle. The needle was advanced into the PQ based upon clinician judgment. Safety was assessed by calculating the distance from the needle to the surrounding neurovascular bundles.

Accurate needle penetration of the PQ was observed in 90% of the cadavers (needle penetration: 19.8 ± 4.0 mm, 95%CI 17.0 to 22.6 mm). No neurovascular bundle was pierced during needling in any specimen forearms. The distance from the tip of the needle was 15.1 ± 4.8 mm (95%CI 11.7 to 18.5 mm) to the ulnar nerve, 15.6 ± 7.6 mm (95%CI 10.0 to 21 mm) to the ulnar artery, 11.2 ± 3.3 mm (95%CI 8.8 to 13.6 mm) to the median nerve, and 4.9 ± 1.4 mm (95%CI 3.9 to 5.9 mm) to the anterior interosseous neurovascular bundle.

The results from this cadaveric study support the assumption that needling of the PQ by the dorsal aspect of the forearm can be accurately and safely conducted by an experienced clinician. Studies investigating the clinical safety and effectiveness of this interventions are needed.