The relative risk to the femoral nerve as a function of patient positioning: potential implications for trigger point dry needling of the iliacus muscle

Andrew M Ball, Michelle Finnegan, Shane Koppenhaver, Will Freres, Jan Dommerholt, Orlando Mayoral Del Moral, Carel Bron, Randy Moore, Erin E Ball, Emily E Gaffney, Andrew M Ball, Michelle Finnegan, Shane Koppenhaver, Will Freres, Jan Dommerholt, Orlando Mayoral Del Moral, Carel Bron, Randy Moore, Erin E Ball, Emily E Gaffney

Abstract

Objectives: Prudent dry needling techniques are commonly practiced with the intent to avoid large neurovascular structures, thereby minimizing potential excessive bleeding and neural injury. Patient position is one factor thought to affect the size of the safe zone during dry needling of some muscles. This study aimed to compare the size of the needle safe zone of the iliacus muscle during two different patient positions using ultrasound imaging. Methods: The distance from the anterior inferior iliac spine (AIIS) to the posterior pole of the femoral nerve was measured in 25 healthy participants (11 male, 14 female, mean age = 40) in both supine and sidelying positions using a Chison Eco1 musculoskeletal ultrasound unit. The average distance was calculated for each position and a two-tailed, paired t-test (α < 0.05) was used to examine the difference between positions. Results: The mean distance from the AIIS to the posterior pole of the femoral nerve was statistically greater with participants in the sidelying position (mean[SD] = 35.7 [6.2] mm) than in the supine position (mean[SD] = 32.1 [7.3] mm, p < .001). Discussion: Although more study is needed, these results suggest that patient positioning is one of several potential variables that should be considered in the optimization of patient safety/relative risk when performing trigger point dry needling. Level of Evidence: Level 4 (Pre-Post Test).

Keywords: Trigger point; dry needle; iliacus; patient position; risk; safety.

Figures

Figure 1.
Figure 1.
Supine MSKUS imaging position and transducer placement. (Inferior approach to final probe placement shown). Note that the reference end of the ultrasound transducer is positioned laterally on the AIIS, with the non-reference end placed medially over the femoral nerve.
Figure 1.
Figure 1.
Supine MSKUS imaging position and transducer placement. (Inferior approach to final probe placement shown). Note that the reference end of the ultrasound transducer is positioned laterally on the AIIS, with the non-reference end placed medially over the femoral nerve.
Figure 2.
Figure 2.
Sidelying MSKUS imaging position and transducer placement. With the transducer firmly held on subject, the image was maintained while re-positioning patient into a sidelying position.
Figure 2.
Figure 2.
Sidelying MSKUS imaging position and transducer placement. With the transducer firmly held on subject, the image was maintained while re-positioning patient into a sidelying position.
Figure 3.
Figure 3.
Artist rendering of anatomical landmarks for study measurement (incircle lower left). Note the study measurement from AIIS to the posterior (deepest) aspect of the triangular femoral nerve.
Figure 3.
Figure 3.
Artist rendering of anatomical landmarks for study measurement (incircle lower left). Note the study measurement from AIIS to the posterior (deepest) aspect of the triangular femoral nerve.
Figure 4.
Figure 4.
MSKUS short-axis/cross-sectional image of AIIS to posterior pole of the triangular-shaped femoral nerve.
Figure 4.
Figure 4.
MSKUS short-axis/cross-sectional image of AIIS to posterior pole of the triangular-shaped femoral nerve.

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