title: Manual needle placement: accuracy of botulinum toxin A injections.
abstract: BACKGROUND
  Electrophysiological or ultrasound guidance can facilitate botulinum toxin A (BoNt-A) injection accuracy, but clinical landmarks and palpation are often used for superficial muscles. We evaluated the accuracy of manual needle placement in the gastrocnemius muscles (GC) guided only by anatomical landmarks and palpation.
  
  
  METHODS
  Bilateral limbs from 30 cadavers were used to evaluate ink injection into the GC. One anatomist and one orthopedic surgeon verified the accuracy of manual needle placement postinjection by calf muscle dissection. Injection was considered a failure if the ink was not located in the head of the target GC.
  
  
  RESULTS
  One hundred twenty-one practitioners were evaluated. Fifty-two injections were successful (43%), and 69 failed (57%). This result was unrelated to injector experience (P = 0.097).
  
  
  CONCLUSIONS
  Our findings show a poor success rate, regardless of injector experience. Therefore, muscle palpation and anatomical landmarks are insufficient to ensure the accuracy of BoNt-A injections, even for large, superficial muscles.
authors.affiliation: Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, AP-HP, University of Versailles Saint Quentin, 104 Boulevard Raymond Poincaré, 92380 Garches, France. alexis.schnitzler@rpc.ap-hop-paris.fr
authors.forename: Alexis
authors.initials: A
authors.lastname: Schnitzler
authors.forename: Nicholas
authors.initials: N
authors.lastname: Roche
authors.forename: Philippe
authors.initials: P
authors.lastname: Denormandie
authors.forename: Christine
authors.initials: C
authors.lastname: Lautridou
authors.forename: Bernard
authors.initials: B
authors.lastname: Parratte
authors.forename: François
authors.initials: F
authors.lastname: Genet
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002102:Cadaver; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy*; D009339:Needles / Q000592:standards*; D009465:Neuromuscular Agents / Q000008:administration & dosage; D010372:Pediatrics / Q000193:education / Q000592:standards; D010810:Physical and Rehabilitation Medicine / Q000193:education* / Q000592:standards*; D010820:Physicians / Q000592:standards
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A