Needle Placement

In general, the needle is placed where the patient describes the most pain or in the location that is most tense to palpation on examination. If the compartment in question is in a deep position or is small, as in the intrinsic muscle compartments of the hand, many surgeons will opt to operate on purely clinical grounds. The forearm is another region that can be difficult because of nervous and vascular structures in the midst of muscle bellys and numerous fascial septa. An accepted technique when the patient has a forearm fracture is to make volar and dorsal punctures adjacent to the fracture, at the carpal tunnel, and a volar puncture proximal to the fracture.6 Of course, surgical consultation would be in order. The deep posterior compartment of the leg is reached by inserting the needle behind the medial surface of the tibia and directing it horizontally to the center of the leg.

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