Is Dry Needling of the Supinator a Safe Procedure? A Potential Treatment for Lateral Epicondylalgia or Radial Tunnel Syndrome. A Cadaveric Study.

César Fernández-De-Las-Peñas,Albert Pérez-Bellmunt,Jacobo Rodríguez-Sanz,Simón A Cedeño-Bermúdez,Carlos López-De-Celis,César Hidalgo-García,Joseph M Donnelly

doi:10.3390/ijerph18179162

Abstract

The supinator muscle is involved in two pain conditions of the forearm and wrist: lateral epicondylalgia and radial tunnel syndrome. Its close anatomical relationship with the radial nerve at the arcade of Frohse encourages research on dry needling approaches. Our aim was to determine if a solid filiform needle safely penetrates the supinator muscle during the clinical application of dry needling. Needle insertion of the supinator muscle was conducted in ten cryopreserved forearm specimens with a 30 × 0.32 mm filiform needle. With the forearm pronated, the needle was inserted perpendicular into the skin at the dorsal aspect of the forearm at a point located 4cm distal to the lateral epicondyle. The needle was advanced to a depth judged to be in the supinator muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles of the radial nerve. Accurate needle penetration of the supinator muscle was observed in 100% of the forearms (needle penetration:16.4 ± 2.7 mm 95% CI 14.5 mm to 18.3 mm). No neurovascular bundle of the radial nerve was pierced in any of the specimen’s forearms. The distances from the tip of the needle were 7.8 ± 2.9 mm (95% CI 5.7 mm to 9.8 mm) to the deep branch of the radial nerve and 8.6 ± 4.3 mm (95% CI 5.5 mm to 11.7 mm) to the superficial branch of the radial nerve. The results from this cadaveric study support the assumption that needling of the supinator muscle can be accurately and safely conducted by an experienced clinician.

Highlights

The results of this study found that dry needling, as applied in clinical practice, penetrates the supinator muscle with an accuracy of 100% when applied by an experienced clinician
Both branches of the radial nerve have an intimate anatomical relationship to the supinator muscle with the superficial radial nerve traversing over the muscle and the deep radial nerve passing through the arcade of Frohse of the muscle
We found that the needle was inserted to a depth of 16.4 ± 2.7 mm to penetrate the supinator muscle, suggesting that no more than 20 mm of the needle should be inserted during clinical application of dry needling of this muscle

Summary

Introduction

The supinator is a deep forearm muscle that surrounds the proximal third of the radius. It is one of the major supinators of the forearm and assists with elbow flexion [1]. It plays a role in the lateral stability of the elbow [1]. Erak et al suggested a biomechanical role for the superficial head of the supinator in the etiology of lateral epicondylalgia by inducing an increase in tensile force in the common wrist extensors tendon [2]. Others have proposed that the referred pain pattern elicited by the supinator muscle

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