title: A new technique for subscapularis muscle needle insertion.
abstract: OBJECTIVE
  To investigate a new technique for needle insertion into the subscapularis muscle for botulinum toxin injection, nerve block with phenol, and electromyography.
  
  
  METHODS
  A new technique, which we have termed the inferior approach, was delineated by cadaver study. In the first step of the study, the thickest part of the subscapularis muscle and the route for the accurate course of the needle were determined by an anatomist on eight cadavers (16 sides). In the second step, using this technique, a physician attempted to inject India ink into the thickest part of the muscle on a separate 12 cadavers (24 sides). The anatomist then examined the accumulated ink by careful dissection of the involved muscle.
  
  
  RESULTS
  The thickest part was determined to be at the lateral half of the muscle. With the exception of two muscles, all the cadavers were successfully injected using the defined route. If the route and injection sites are correct, there is no risk of injecting any muscle in that anatomic region other than the subscapularis. Furthermore, there were no neurovascular structures identified at risk in the area using the inferior approach.
  
  
  CONCLUSIONS
  This new technique, termed the inferior approach, is both easy and anatomically safe: it did not involve any risk of damage to any major artery, vein, or nerve.
authors.affiliation: Department of Physical Therapy and Rehabilitation, Yildirim Beyazit Training and Research Hospital, Diskapi, Ankara, Turkey.
authors.forename: Ece
authors.initials: E
authors.lastname: Unlu
authors.forename: Tulin
authors.initials: T
authors.lastname: Sen
authors.forename: Ali Firat
authors.initials: AF
authors.lastname: Esmer
authors.forename: Eray
authors.initials: E
authors.lastname: Tuccar
authors.forename: Alaittin
authors.initials: A
authors.lastname: Elhan
authors.forename: Aytül
authors.initials: A
authors.lastname: Cakci
mesh_terms: D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage; D001905:Botulinum Toxins / Q000008:administration & dosage; D002102:Cadaver; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D012785:Shoulder Joint
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins