Technique for iliopsoas ultrasound-guided active electromyography-directed botulinum a toxin injection in cerebral palsy.
Symptomatic hip flexion deformity secondary to iliopsoas spasticity may interfere with gait, impair sitting balance, or contribute to hip subluxation or dislocation. A nonsurgical, minimally invasive technique to ameliorate iliopsoas spasticity is presented. The technique uses intramuscular injections of botulinum A toxin to provide selective neuromuscular blockade of the iliacus or psoas muscles or both. Because of the anatomic location of the target muscles, this technique uses ultrasound guidance for needle placement. Active electromyographic stimulation is used to verify the needle position adjacent to active myoneural interfaces. The authors' experience to date includes the treatment of 28 patients (53 hips). Use of this technique has resulted in improved hip range of motion. No intraoperative or postoperative adverse events or complications have been observed.
Willenborg
Michael J
MJ
Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Shilt
Jeffrey S
JS
Smith
Beth Paterson
BP
Estrada
Roquel L
RL
Castle
Jason A
JA
Koman
L Andrew
LA
D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000188:drug therapy*; D004576:Electromyography / Q000379:methods*; D005260:Female; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods; D008297:Male; D016658:Psoas Muscles / Q000000981:diagnostic imaging; D014463:Ultrasonography
D019274:Botulinum Toxins, Type A