title: Accuracy of botulinum toxin type A injection into the forearm muscles of chronic stroke patients with spastic flexed wrist and clenched fist: manual needle placement evaluated using ultrasonography.
abstract: OBJECTIVE
  To investigate the accuracy of manual needle placement for injection of botulinum toxin type A into the forearm muscles of adults with spastic flexed wrist and clenched fist as a consequence of stroke.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  A total of 41 adults with chronic stroke who were scheduled to receive botulinum toxin type A injection into the following forearm muscles: flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis and flexor digitorum profundus.
  
  
  METHODS
  According to Huber & Heck's atlas suggestions on treatment of spasticity with botulinum toxin, surface identification of muscles to inject was performed by means of palpation and anatomical landmarks. Accuracy of needle placement and muscle thickness at the site of needle insertion were assessed using ultrasonography.
  
  
  RESULTS
  Overall accuracy of manual needle placement evaluated using ultrasonography was 51.2%. Accuracy was significantly higher for the finger flexors than for the wrist flexors (63.4% vs 39.0%). The finger flexors were significantly thicker than the wrist flexors (mean 1.58 vs 0.49 cm).
  
  
  CONCLUSIONS
  Instrumental guidance should be used in order to achieve an acceptable accuracy of needle placement when performing botulinum toxin type A injections into the forearm muscles of chronic stroke patients with spastic flexed wrist and clenched fist.
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Italy. P.le L.A. Scuro, 10, IT-37134 Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Picelli
authors.forename: Laura
authors.initials: L
authors.lastname: Roncari
authors.forename: Silvia
authors.initials: S
authors.lastname: Baldessarelli
authors.forename: Giulia
authors.initials: G
authors.lastname: Berto
authors.forename: Davide
authors.initials: D
authors.lastname: Lobba
authors.forename: Andrea
authors.initials: A
authors.lastname: Santamato
authors.forename: Pietro
authors.initials: P
authors.lastname: Fiore
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005542:Forearm / Q000000981:diagnostic imaging; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D009339:Needles; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome; D014463:Ultrasonography; D014953:Wrist / Q000000981:diagnostic imaging
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A