title: Optimal Needle Placement for Extensor Hallucis Longus Muscle: A Cadaveric Study.
abstract: OBJECTIVE
  To determine the midpoint (MD) of extensor hallucis longus muscle (EHL) and compare the accuracy of different needle electromyography (EMG) insertion techniques through cadaver dissection.
  
  
  METHODS
  Thirty-eight limbs of 19 cadavers were dissected. The MD of EHL was marked at the middle of the musculotendinous junction and proximal origin of EHL. Three different needle insertion points of EHL were marked following three different textbooks: M1, 3 fingerbreadths above bimalleolar line (BML); M2, junction between the middle and lower third of tibia; M3, 15 cm proximal to the lower border of both malleoli. The distance from BML to MD (BML_MD), and the difference between 3 different points (M1-3) and MD were measured (designated D1, D2, and D3, respectively). The lower leg length (LL) was measured from BML to top of medial condyle of tibia.
  
  
  RESULTS
  The median value of LL was 34.5 cm and BML_MD was 12.0 cm. The percentage of BML_MD to LL was 35.1%. D1, D2, and D3 were 7.0, 0.9, and 3.0 cm, respectively. D2 was the shortest, meaning needle placement following technique by Lee and DeLisa was closest to the actual midpoint of EHL.
  
  
  CONCLUSIONS
  The MD of EHL is approximately 12 cm above BML, and about distal 35% of lower leg length. Technique that recommends placing the needle at distal two-thirds of the lower leg (M2) is the most accurate method since the point was closest to muscle belly of EHL.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.
authors.forename: In Yae
authors.identifier: 0000-0003-3621-6017
authors.initials: IY
authors.lastname: Cheong
authors.affiliation: Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.
authors.forename: Do Kyun
authors.identifier: 0000-0002-3257-6683
authors.initials: do K
authors.lastname: Kim
authors.affiliation: School of Kinesiology, University of British Columbia, Vancouver, Canada.
authors.forename: Ye Jeong
authors.identifier: 0000-0002-3832-6108
authors.initials: YJ
authors.lastname: Oh
authors.affiliation: Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.
authors.forename: Byung Kyu
authors.identifier: 0000-0001-8445-7099
authors.initials: BK
authors.lastname: Park
authors.affiliation: Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.
authors.forename: Ki Hoon
authors.identifier: 0000-0002-7257-3858
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.
authors.forename: Dong Hwee
authors.identifier: 0000-0002-8116-0078
authors.initials: DH
authors.lastname: Kim
keywords: Cadaver; Electromyography; Extensor hallucis longus muscle; Needles