title: Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography.
abstract: OBJECTIVE
  To investigate the accuracy of manual needle placement into gastrocnemius muscle (GCM) for botulinum toxin type A (BTX-A) injection in children with spastic cerebral palsy (CP).
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  A total of 272 injections in GCMs of 39 children with spastic CP who were scheduled to receive BTX-A injections in GCMs.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  The accuracy of manual needle placement was checked against ultrasonography.
  
  
  RESULTS
  The needle was accurately inserted into GCM muscles in 78.7% of cases. Accuracy was 92.6% into gastrocnemius medialis (GM) and 64.7% into gastrocnemuis lateralis (GL). Muscle thickness at the needle insertion site was significantly thinner in GL than GM. Accuracy of GL in the younger age group (<4y, 57.6%) was lower than in the older age group (> or =4y, 78.1%). For GM, accuracy in both younger and older age groups was good (>90%).
  
  
  CONCLUSIONS
  Injection of the toxin into GCMs through the use of anatomic landmark was acceptable in GM, but not acceptable in GL, especially in young children.
authors.affiliation: Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Yang
authors.forename: Dong-wook
authors.initials: DW
authors.lastname: Rha
authors.forename: Jun Ki
authors.initials: JK
authors.lastname: Yoo
authors.forename: Eun Sook
authors.initials: ES
authors.lastname: Park
mesh_terms: D000367:Age Factors; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000534:rehabilitation; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D016015:Logistic Models; D008297:Male; D009126:Muscle Relaxation / Q000187:drug effects; D009128:Muscle Spasticity; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging* / Q000187:drug effects*; D009339:Needles; D016017:Odds Ratio; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D019274:Botulinum Toxins, Type A