Precautions Flashcards
Gluteus Maximus
Sciatic nerve
Gluteus Medius
Joint capsule of the hip and the sciatic nerve
Gluteus Minimus
Joint capsule of the hip and the sciatic nerve
Piriformis
Sciatic nerve
Iliopsoas
Ilioinguinal and lateral femoral cutaneous nerves (when needling iliacus).
Femoral nerve, artery and vein (when needling insertion/distally).
Quadratus Femoris
Sciatic nerve, joint capsule of the hip.
Tensor Fascia Latae
None
Sartorius
Femoral triangle and associated structures
Rectus Femoris
Femoral artery and nerve (femoral triangle).
Vastus Lateralis
None
Vastus Medialis
Femoral artery and femoral nerve
Vastus Intermedius
None
Biceps Femoris
Throughout the posterior thigh the sciatic nerve lies deep to the hamstring muscles. The tibial nerve must also be avoided.
Semitendinosus
Sciatic nerve, popliteal artery, tibial nerve
Semimembranosus
Sciatic nerve, popliteal artery, tibial nerve.
Adductor Longus
Femoral artery, nerve and vein (femoral triangle)
Adductor Brevis
Femoral artery, nerve and vein (femoral triangle)
Adductor Magnus
Femoral nerve, artery & vein. Caution with the sciatic nerve as it passes between the adductor magnus and the hamstring muscles.
Pectineus
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.
Gracilis
None
Gastrocnemius
Popliteal fossa and associated neurovascular structures.
Soleus
Tibial nerve and posterior tibial artery and veins particularly if required to needle in the midline of the muscle.
Peroneus Longus
The common peroneal nerve (common fibular nerve) enters the anterior leg through a gap between the two origins of the muscle
Peroneus Brevis
The common peroneal nerve (common fibular nerve) enters the anterior leg through a gap between the two origins of the muscle
Tibialis Anterior
Anterior tibial artery, vein and deep peroneal nerve
Extensor Hallucis Longus
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.
FLEXOR HALLUCIS BREVIS
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.
QUADRATUS PLANTAE
Medial and lateral plantar nerves and lateral plantar artery.
Flexor Hallucis Longus
Tibial nerve, posterior tibial vessels and peroneal vessels.
EXTENSOR DIGITORUM BREVIS
The deep peroneal nerve runs medial to the extensor hallucis brevis muscle, and therefore angling the needle in a medial direction should be avoided.
ABDUCTOR HALLICIS
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.
Flexor Digitorum Longus
Tibial nerve, posterior tibial vessels and peroneal vessels.
Rectus Abdominis
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.
