• Sang Chul Lee, Dong-wook Rha, Hee-Jin Kim, Hun-mu Yang, Sang-Hee Lee, and DongJin Koh.
• From the *Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine; †Division in Anatomy and Developmental Biology, Department of Oral Biology, BK21 PLUS Project, Human Identification Research Center, Yonsei University College of Dentistry, Seoul; and ‡Department of Anatomy, College of Medicine, Dankook University, Cheonan, Republic of Korea.
• Reg Anesth Pain Med. 2014 Jul 1;39(4):347-50.

Background And ObjectivesMusculoskeletal dysfunction of the pelvic floor is common. One of the intrapelvic muscles, the obturator internus (OI), can be substantially stressed during its sharply angulated exit from the pelvis. However, there may be considerable overlap between symptoms and signs arising from the OI and other potential pain generators including the levator ani in the pelvic region. Accurate diagnosis for the OI might permit more efficient treatment combined with OI-specific exercise and behavior modification. Therefore, we hypothesized that ultrasound (US)-guided needle insertion in the intrapelvic portion of the OI would be accurate when a pararectal approach is used for diagnostic and therapeutic purposes.MethodsBilateral US-guided intramuscular injections in the pelvic area were performed using 6 fresh, nonembalmed male cadavers. When the needle was positioned in the targeted muscle, 0.5 mL of green filler was injected. After the injection procedure, each specimen was dissected to evaluate the accuracy of US-guided injection into the intrapelvic portion of the OI.ResultsTwelve injections were made into the targeted muscles in the 6 cadaveric specimens. All injections placed filler into the OI muscles just medial to the inferior pubic ramus. There was no case in which a needle passed through unintended structures, such as neurovascular structures.ConclusionsThe newly developed US-guided pararectal approach allowed accurate insertion of a needle into the intrapelvic portion of the OI. This US-guided method facilitated a more precise approach to the intrapelvic portion of the OI and may help differentiate conditions or symptoms caused by other structures.

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