Prediction model for minimizing the risk of median nerve puncture with dry needling approach at pronator teres muscle. Muñoz-GarcÃa, D.1,2; Ferrer-Peña R.1,2; ...
Prediction model for minimizing the risk of median nerve puncture with dry needling approach at pronator teres muscle. Muñoz-García, D.1,2; Ferrer-Peña R.1,2; Valera-Calero, JA.3; Conde Lima, R.3; del Río Santamaría, I.4 1. Departamento de Fisioterapia. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid. (España) 2. Grupo de Investigación de Ciencias del Movimiento, Bioconducta y estudio del dolor - Motion in Brains. Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid. Madrid. (España) 3. Fisioterapeuta en el ejercicio libre de la profesión. 4. Fisioterapeuta. Servicio de Rehabilitación Hospital Recoletas. Burgos
BACKGROUND The pronator teres is located in the anterior forearm; anatomically, it is described as having two heads, i.e., the ulnar head and the humeral head. The median nerve runs Between the two heads and leaves the muscle 5 to 8 cm distal the lateral epicondyle; however, some variations are possible in this distribution. Pronator teres syndrome is a median nerve compression condition that causes 5% of median neuropathies, and it is a common cause of medial epicondylitis and carpal tunnel syndrome. One treatment for these conditions is dry needling approach for the pronator teres trigger points. The use of the ultrasound prevents the formation of lesions in the medial nerve, which it is an undesirable effect of this technique. The main aim of this study was to correlate anthropometric measures of the forearm in healthy subjects with the depth of the pronator teres to guide the decision of the choice of the length of needle in order to avoid injury to the nerve during the dry needle approach.
RESULTS
METHODS
The algorithm showed a sensitivity of 87.7% for predicting depth using the forearm
In a cross-sectional study with a total of 65 participants, a predictive model for median
circumference. When the patient’s forearm circumference is less than or equal to 27.5
nerve depth in the pronator teres was constructed using a Decision Tree Analysis
cm, the predictive value for using the 13 mm needle is 92%, and when the patient’s
algorithm (SPSS 22.0, IBM, Armonk, NY, USA). This provides a clinically
forearm circumference is more than 27.5 cm, the 25mm needle can be uses with 100%
comprehensive classification algorithm for clinical practice that will allow clinicians to
confidence when the forearm length also does not exceed 27 cm.
profile the individual risk for a given patient using two needle lengths (13mm or 25mm).
CONCLUSION
The decision tree was developed using an exhaustive Chi-squared Automatic Interaction Detector (CHAID), i.e., a recursive partitioning method that builds classification trees for predicting categorical predictor variables by automatically selecting a cut-off for all parameters, including body mass index (kg/m2), forearm length, forearm
Research using ultrasound can help improve clinical decision making when proceeding with dry needling to avoid damage to the median nerve. Nevertheless, ultrasound guided dry needling approach is recommended
circumference, and pronator teres thickness.
DECISION TREE ANALYSIS
26,75
Node 3 Category % 13mm Needle 97,4 25mm Needle 2,6 Total 60,0
n 38 1 39
Node 4 Category % 13mm Needle 72,7 25mm Needle 27,3 Total 16,9
n 8 3 11
Node5 Category % 13mm Needle 0 25mm Needle 100,0 Total 7,7
n 0 5 5
Node 6 Category % 13mm Needle 60 25mm Needle 40 Total 15,4
n 6 4 10
