Adductor Tendon Percutaneous Needle Tenotomy

Other Names

Normal anatomy of the proximal adductor muscles. The adductor (Add) longus muscle originates at the anterior pubic bone and forms a common aponeurosis with the rectus abdominis (abd) muscle. The adductor brevis and magnus muscles are located posteriorly and the gracilis muscle medially.

• Adductor Needle Tenotomy
• Adductor Tendon Percutaneous Needle Tenotomy
• Adductor Tendon Needle Tenotomy

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Background

Key Points

• Transducer: high frequency, linear
• Needle: 21-22 gauge, 2 inch is usually sufficient

Anatomy of the Hip Adductor Group

• Muscles of Interest: adductor magnus, adductor longus, adductor brevis
• Additional adductors: pectineus, gracilis, obturator externus

Palpation vs Ultrasound Guidance

• There are no papers comparing palpation vs ultrasound guided tendon sheath injection
• We recommend ultrasound guidance to increase needle precision and accuracy

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Indications

• Adductor Tendonitis

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Contraindications

• Absolute
  • Anaphylaxis to injectates
  • Overlying cellulitis, skin lesion or systemic infection
• Relative
  • Can be treated with less invasive means
  • Hyperglycemia or poorly controlled diabetes
  • Lack of symptom improvement with previous injection

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Procedure

Ultrasound of long axis, in plane approach. A, Longitudinal ultrasound (US) image of the proximal adductor. B, Injection under direct US control. Abbreviations are: PT, pubic tubercle; AL, adductor longus; AB, adductor brevis; AM, adductor magnus; dotted arrow, needle shaft

Needle and probe position

Equipment

• Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
• Gloves
• Needle: typically 21-25 gauge, 1.5 inch
• Syringe: 5-10 mL
• Gauze
• Ethyl Chloride
• Bandage
• Injectate
  • Local anesthetic
  • Corticosteroid
• Sterile probe cover

Ultrasound Findings

• Patient position: supine
  • Hip slightly flexed and externally rotated
• Scanning Protocol
  • Identify adductor longus in long axis
  • Deep is adductor brevis, adductor magnus
  • Scan cephalad toward the pubic symphysis
  • Can find pectineus, gracilis proximally
  • Look in short axis
• Common ultrasound findings include
  • Peritendinous inflammation
  • Anechoic fluid in tendon sheath

Technique: Short Axis, In Plane

• Patient Position
  • Supine
  • Limb externally rotated, abducted, knee partially flexed
• Transducer position
  • Long axis to adductor longus muscle for orientation
  • For injection, rotate probe to short axis of tendon sheath
• Needle Approach/ Orientation
  • In plane
  • Distal to proximal
• Target
  • Anechoid fluid between tendon and tendon sheath
• Pearls and Pitfalls
  • Identify adductor longus tendon first as your point of reference

Technique: Long Axis, In Plane

• Patient Position
  • Supine
  • Limb externally rotated, abducted, knee partially flexed
• Transducer position
  • Long axis to adductor longus muscle/ tendon
• Needle Approach/ Orientation
  • In plane
  • Distal to proximal
• Target
  • Anechoic fluid between tendon and tendon sheath
• Pearls and Pitfalls
  • Rotate probe short axis to view the width of the tendon
  • Identify adductor longus tendon first as your point of reference

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Aftercare

• No significant restrictions
• Can augment with ice, NSAIDS

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Complications

• Skin: Subcutaneous fat atrophy, skin atrophy, skin depigmentation
• Painful local reaction
• Infection
• Hyperglycemia
• Tendon, nerve or blood vessel injury

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See Also

Internal

• Procedures Main
• Ultrasound Main
• Hip Pain Main

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