Ultrasound guided injection of Adductor longus and Pectineus
MSK ultrasound guidance guarantees accuracy and safety in the insertion of a needle at the proximal part of Adductor longus (AL) and Pectineus (P) in a cadaver model. When performing an injection at that area, due to proximity of the neurovascular bundle and the anatomical contiguity of both muscles, ultrasound guidance becomes a must.
The intramuscular injections (blue dye) following an in-plane approach were performed in cadavers with the hip externally rotated and slightly abducted. For the AL, the probe was positioned in the short axis of the hip adductors belly; once the AL is depicted, the probe is rotated to show the long axis of the muscle. By scanning AL and P at a more distal portion in the short axis, the P is easily differentiated, and simple to trace to its origin. The anatomical dissection revealed that the target zone was reached with precision and the nearby femoral neurovascular structures and obturator nerve were not damaged.
The management of inguinal pain is a challenge, in which myofascial trigger points of AL and P can be responsible and frequently misdiagnosed as a chronic pain pelvic syndrome (CPPS). The ultrasound guided injection technique may play a role to illuminate the diagnosis and treatment of inguinal pain.
> From: Rha et al., Pain Physician 18 (2016) E1111- E1117. All rights reserved to Pain Physician. Click here for the Pubmed summary.