Optimizing injection accuracy for Baxter’s nerve entrapment: an ultrasonography-guided approach based on anatomical surface landmarks

Introduction The clinical feasibility and applicability of surface landmarks for Baxter nerve entrapment to proximal and distal sites is unclear. This study provides anatomical guidelines for optimal transducer placement using two specific landmarks, the most inferior tip of the medial malleolus (A)...

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Main Authors: Jung-woo Choi, Hyung-Jin Lee, Yong-Seok Nam, Mi Young Shin, Sang-Hyun Kim, Jun-Ho Kim, In-Beom Kim
Format: Article
Language:English
Published: Taylor & Francis Group 2025-12-01
Series:Annals of Medicine
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Online Access:https://www.tandfonline.com/doi/10.1080/07853890.2025.2450525
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author Jung-woo Choi
Hyung-Jin Lee
Yong-Seok Nam
Mi Young Shin
Sang-Hyun Kim
Jun-Ho Kim
In-Beom Kim
author_facet Jung-woo Choi
Hyung-Jin Lee
Yong-Seok Nam
Mi Young Shin
Sang-Hyun Kim
Jun-Ho Kim
In-Beom Kim
author_sort Jung-woo Choi
collection DOAJ
description Introduction The clinical feasibility and applicability of surface landmarks for Baxter nerve entrapment to proximal and distal sites is unclear. This study provides anatomical guidelines for optimal transducer placement using two specific landmarks, the most inferior tip of the medial malleolus (A) and the most protruding posterior tip of the calcaneus (B), to enhance the diagnostic and therapeutic injection efficacy for proximal and distal entrapment sites.Materials and Methods Eighty-six feet from 45 fresh cadavers (25 male and 20 female) were dissected to determine Baxter’s nerve (BN) localization. With A and B as key landmarks, distances (OB, OBN, BBN, and BNx) were measured to accurately localize the nerve. The OB distance was divided into four equal-length quadrants or zones. Twenty feet from 10 fresh cadavers (5 males and 5 females) underwent ultrasonography-guided injection using in-plane and out-of-plane techniques. Two practitioners marked the landmarks to ensure reproducibility and an experienced anesthesiologist administered the injections. The spread of the injected dye was assessed, and statistical analyses were conducted.Results Average OB, OBN, BBN, and BNx distances were 50.55 ± 5.83 mm, 7.19 ± 5.85 mm, 43.77 ± 5.31 mm, and 12.13 ± 5.75 mm, respectively. Significant sex-related differences (O to B; B to BN) and notable disparities between the distances on the right and left sides (O to BN; BN to X-axis) were observed. Most of the BN (81.4%) was located in zone 1, representing 25% of the OB length. For entrapment site 1, the in-plane technique achieved a 100% success rate whereas the out-of-plane method achieved an 80% success rate. For entrapment site 2, the out-of-plane approach (90% success) outperformed the in-plane approach (20% success).Conclusion Using two specific landmarks provides reliable guidelines for optimal transducer placement during injections targeting compressive neuropathy at proximal and distal entrapment sites.
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spelling doaj-art-006bfc06c7db4fb0b5c5d92554d43daf2025-01-08T08:47:15ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602025-12-0157110.1080/07853890.2025.2450525Optimizing injection accuracy for Baxter’s nerve entrapment: an ultrasonography-guided approach based on anatomical surface landmarksJung-woo Choi0Hyung-Jin Lee1Yong-Seok Nam2Mi Young Shin3Sang-Hyun Kim4Jun-Ho Kim5In-Beom Kim6Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of KoreaCatholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of KoreaDepartment of Anatomy, School of Medicine, Kyungpook National University, Daegu, Republic of KoreaAnapa Pain Clinic, Seoul, Republic of KoreaCatholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of KoreaCatholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of KoreaCatholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of KoreaIntroduction The clinical feasibility and applicability of surface landmarks for Baxter nerve entrapment to proximal and distal sites is unclear. This study provides anatomical guidelines for optimal transducer placement using two specific landmarks, the most inferior tip of the medial malleolus (A) and the most protruding posterior tip of the calcaneus (B), to enhance the diagnostic and therapeutic injection efficacy for proximal and distal entrapment sites.Materials and Methods Eighty-six feet from 45 fresh cadavers (25 male and 20 female) were dissected to determine Baxter’s nerve (BN) localization. With A and B as key landmarks, distances (OB, OBN, BBN, and BNx) were measured to accurately localize the nerve. The OB distance was divided into four equal-length quadrants or zones. Twenty feet from 10 fresh cadavers (5 males and 5 females) underwent ultrasonography-guided injection using in-plane and out-of-plane techniques. Two practitioners marked the landmarks to ensure reproducibility and an experienced anesthesiologist administered the injections. The spread of the injected dye was assessed, and statistical analyses were conducted.Results Average OB, OBN, BBN, and BNx distances were 50.55 ± 5.83 mm, 7.19 ± 5.85 mm, 43.77 ± 5.31 mm, and 12.13 ± 5.75 mm, respectively. Significant sex-related differences (O to B; B to BN) and notable disparities between the distances on the right and left sides (O to BN; BN to X-axis) were observed. Most of the BN (81.4%) was located in zone 1, representing 25% of the OB length. For entrapment site 1, the in-plane technique achieved a 100% success rate whereas the out-of-plane method achieved an 80% success rate. For entrapment site 2, the out-of-plane approach (90% success) outperformed the in-plane approach (20% success).Conclusion Using two specific landmarks provides reliable guidelines for optimal transducer placement during injections targeting compressive neuropathy at proximal and distal entrapment sites.https://www.tandfonline.com/doi/10.1080/07853890.2025.2450525Baxter’s nerveultrasonographyinjectionsurface anatomy
spellingShingle Jung-woo Choi
Hyung-Jin Lee
Yong-Seok Nam
Mi Young Shin
Sang-Hyun Kim
Jun-Ho Kim
In-Beom Kim
Optimizing injection accuracy for Baxter’s nerve entrapment: an ultrasonography-guided approach based on anatomical surface landmarks
Annals of Medicine
Baxter’s nerve
ultrasonography
injection
surface anatomy
title Optimizing injection accuracy for Baxter’s nerve entrapment: an ultrasonography-guided approach based on anatomical surface landmarks
title_full Optimizing injection accuracy for Baxter’s nerve entrapment: an ultrasonography-guided approach based on anatomical surface landmarks
title_fullStr Optimizing injection accuracy for Baxter’s nerve entrapment: an ultrasonography-guided approach based on anatomical surface landmarks
title_full_unstemmed Optimizing injection accuracy for Baxter’s nerve entrapment: an ultrasonography-guided approach based on anatomical surface landmarks
title_short Optimizing injection accuracy for Baxter’s nerve entrapment: an ultrasonography-guided approach based on anatomical surface landmarks
title_sort optimizing injection accuracy for baxter s nerve entrapment an ultrasonography guided approach based on anatomical surface landmarks
topic Baxter’s nerve
ultrasonography
injection
surface anatomy
url https://www.tandfonline.com/doi/10.1080/07853890.2025.2450525
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