Precautions

Question 1

Gluteus Maximus

Answer 1

Sciatic nerve

Question 2

Gluteus Medius

Answer 2

Joint capsule of the hip and the sciatic nerve

Question 3

Gluteus Minimus

Answer 3

Joint capsule of the hip and the sciatic nerve

Question 4

Piriformis

Answer 4

Sciatic nerve

Question 5

Iliopsoas

Answer 5

Ilioinguinal and lateral femoral cutaneous nerves (when needling iliacus).
Femoral nerve, artery and vein (when needling insertion/distally).

Question 6

Quadratus Femoris

Answer 6

Sciatic nerve, joint capsule of the hip.

Question 7

Tensor Fascia Latae

Answer 7

None

Question 8

Sartorius

Answer 8

Femoral triangle and associated structures

Question 9

Rectus Femoris

Answer 9

Femoral artery and nerve (femoral triangle).

Question 10

Vastus Lateralis

Answer 10

None

Question 11

Vastus Medialis

Answer 11

Femoral artery and femoral nerve

Question 12

Vastus Intermedius

Answer 12

None

Question 13

Biceps Femoris

Answer 13

Throughout the posterior thigh the sciatic nerve lies deep to the hamstring muscles. The tibial nerve must also be avoided.

Question 14

Semitendinosus

Answer 14

Sciatic nerve, popliteal artery, tibial nerve

Question 15

Semimembranosus

Answer 15

Sciatic nerve, popliteal artery, tibial nerve.

Question 16

Adductor Longus

Answer 16

Femoral artery, nerve and vein (femoral triangle)

Question 17

Adductor Brevis

Answer 17

Femoral artery, nerve and vein (femoral triangle)

Question 18

Adductor Magnus

Answer 18

Femoral nerve, artery & vein. Caution with the sciatic nerve as it passes between the adductor magnus and the hamstring muscles.

Question 19

Pectineus

Answer 19

The femoral triangle, from medial to lateral, houses the femoral vein, femoral artery, and the femoral nerve. Care must be taken to stay to the medial side of these structures through good patient positioning and accurate palpation.

Question 20

Gracilis

Answer 20

None

Question 21

Gastrocnemius

Answer 21

Popliteal fossa and associated neurovascular structures.

Question 22

Soleus

Answer 22

Tibial nerve and posterior tibial artery and veins particularly if required to needle in the midline of the muscle.

Question 23

Peroneus Longus

Answer 23

The common peroneal nerve (common fibular nerve) enters the anterior leg through a gap between the two origins of the muscle

Question 24

Peroneus Brevis

Answer 24

The common peroneal nerve (common fibular nerve) enters the anterior leg through a gap between the two origins of the muscle

Question 25

Tibialis Anterior

Answer 25

Anterior tibial artery, vein and deep peroneal nerve

Question 26

Extensor Hallucis Longus

Answer 26

Needling the extensor hallucis longus is generally not recommended and should be considered only if the taut band and TrP tenderness has been clearly localised and their depth determined. If needling is to be used care must be taken as to the depth of penetration.

Question 27

FLEXOR HALLUCIS BREVIS

Answer 27

The proper planter nerve (division of the medial planter nerve) runs adjacent to the to the planter surface of the medial head of this muscle. Careful insertion, staying close to the bone should avoid this nerve.

Question 28

QUADRATUS PLANTAE

Answer 28

Medial and lateral plantar nerves and lateral plantar artery.

Question 29

Flexor Hallucis Longus

Answer 29

Tibial nerve, posterior tibial vessels and peroneal vessels.

Question 30

EXTENSOR DIGITORUM BREVIS

Answer 30

The deep peroneal nerve runs medial to the extensor hallucis brevis muscle, and therefore angling the needle in a medial direction should be avoided.

Question 31

ABDUCTOR HALLICIS

Answer 31

The neurovascular bundle of the tibialis posterior vessels and medial and lateral planter nerves that pass deep to the proximal third of this muscle should be avoided.

Question 32

Flexor Digitorum Longus

Answer 32

Tibial nerve, posterior tibial vessels and peroneal vessels.

Question 33

Rectus Abdominis

Answer 33

Traumatic pneumothorax with upper TrPs, always needle below costal margin and use extreme care if there is difficulty palpating the costal margins.
Penetration of the abdominal cavity and its viscera. Extreme care to be taken with needling this region.
Note- consider asking patient to empty bladder prior to needling lower TrPs.