Article

OBJECTIVE: To investigate the accuracy of manual needle placement for injection
of botulinum toxin type A into the forearm muscles of adults with spastic flexed
wrist and clenched fist as a consequence of stroke. DESIGN: Prospective clinical
study. PATIENTS: A total of 41 adults with chronic stroke who were scheduled to
receive botulinum toxin type A injection into the following forearm muscles:
flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis and
flexor digitorum profundus. METHODS: According to Huber & Heck's atlas
suggestions on treatment of spasticity with botulinum toxin, surface
identification of muscles to inject was performed by means of palpation and
anatomical landmarks. Accuracy of needle placement and muscle thickness at the
site of needle insertion were assessed using ultrasonography. RESULTS: Overall
accuracy of manual needle placement evaluated using ultrasonography was 51.2%.
Accuracy was significantly higher for the finger flexors than for the wrist
flexors (63.4% vs 39.0%). The finger flexors were significantly thicker than the
wrist flexors (mean 1.58 vs 0.49 cm). CONCLUSION: Instrumental guidance should be
used in order to achieve an acceptable accuracy of needle placement when
performing botulinum toxin type A injections into the forearm muscles of chronic
stroke patients with spastic flexed wrist and clenched fist.

Langue : ANGLAIS