Article

OBJEctive: To compare the outcome of manual needle placement, electrical
stimulation and ultrasonography-guided techniques for botulinum toxin injection
into the forearm muscles of adults with arm spasticity. DESIGN: Randomized
controlled trial. SETTING: University hospital. SUBJECTS: Sixty chronic stroke
patients with wrist and fingers spasticity. INTERVENTION: After randomization
into three groups, each patient received botulinum toxin type A in at least two
of these muscles: flexor carpi radialis and ulnaris, flexor digitorum
superficialis and profundus (no fascicles selection). The manual needle placement
group underwent injections using palpation; the electrical stimulation group
received injections with electrical stimulation guidance; the ultrasonography
group was injected under sonographic guidance. A sole injector was used. MAIN
MEASURES: All patients were evaluated at baseline and four weeks after injection.
Outcomes: Modified Ashworth Scale; Tardieu Scale; wrist and fingers passive range
of motion. RESULTS: One month after injection, Modified Ashworth Scale scores
improved more in the electrical stimulation group than the manual needle
placement group (wrist: P = 0.014; fingers: P = 0.011), as well as the Tardieu
angle (wrist: P = 0.008; fingers: P = 0.015) and passive range of motion (wrist:
P = 0.004). Furthermore, Modified Ashworth Scale scores improved more in the
ultrasonography group than in the manual needle placement group (wrist: P =
0.001; fingers: P = 0.003), as well as the Tardieu angle (wrist: P = 0.010;
fingers: P = 0.001) and passive range of motion (wrist: P < 0.001; proximal
interphalangeal joints: P = 0.009). No difference was found between the
ultrasonography and electrical stimulation groups. CONCLUSIONS: Instrumental
guidance may improve the outcome of botulinum toxin injections into the spastic
forearm muscles of stroke patients.

Langue : ANGLAIS