Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography.
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.
Yang
Eun Joo
EJ
Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Rha
Dong-wook
DW
Yoo
Jun Ki
JK
Park
Eun Sook
ES
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
D019274:Botulinum Toxins, Type A