title: Accuracy of botulinum toxin type A injection into the gastrocnemius muscle of adults with spastic equinus: manual needle placement and electrical stimulation guidance compared using ultrasonography.
abstract: OBJECTIVE
  To investigate the accuracy of manual needle placement and electrical stimulation guidance, compared using ultrasonography, for injection of botulinum toxin type A into the gastrocnemius muscle of adults with spastic equinus.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  A total of 81 adults with stroke who were scheduled to receive botulinum toxin type A injection into the gastrocnemius muscle.
  
  
  METHODS
  After randomization into two groups, each patient was injected into two sites at each head of the gastrocnemius muscle. The manual needle placement group (n = 42) underwent injections using anatomical landmarks and palpation. The electrical stimulation guidance group (n = 39) underwent injections under electrical stimulation guidance. The accuracy of needle placement and muscle thickness at each injection site were compared by means of ultrasonography.
  
  
  RESULTS
  The overall accuracy of manual needle placement and electrical stimulation guidance, measured using ultrasonography, was significantly higher for the gastrocnemius medialis than for the lateralis (92.0% vs 79.0%). The gastrocnemius medialis was significantly thicker than the lateralis (mean 13.25 mm (standard deviation (SD) 1.86 mm) vs 10.84 mm (SD 1.52 mm).
  
  
  CONCLUSIONS
  Electrical stimulation guidance may be useful for injections into the gastrocnemius lateralis of adults with spastic equinus. However, neither manual needle placement nor electrical stimulation guidance showed complete accuracy, when measured using ultrasonography.
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Picelli
authors.forename: Paola
authors.initials: P
authors.lastname: Bonetti
authors.forename: Carla
authors.initials: C
authors.lastname: Fontana
authors.forename: Martina
authors.initials: M
authors.lastname: Barausse
authors.forename: Francesca
authors.initials: F
authors.lastname: Dambruoso
authors.forename: Francesca
authors.initials: F
authors.lastname: Gajofatto
authors.forename: Stefano
authors.initials: S
authors.lastname: Tamburin
authors.forename: Paolo
authors.initials: P
authors.lastname: Girardi
authors.forename: Raffaele
authors.initials: R
authors.lastname: Gimigliano
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009128:Muscle Spasticity / Q000188:drug therapy*; D018482:Muscle, Skeletal / Q000187:drug effects*; D009339:Needles; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A