title: Can botulinum toxin type A injection technique influence the clinical outcome of patients with post-stroke upper limb spasticity? A randomized controlled trial comparing manual needle placement and ultrasound-guided injection techniques.
abstract: BACKGROUND
  Botulinum toxin type A is a first-line treatment for post-stroke focal spasticity, and the accuracy in delivering the toxin to the target muscles may influence the treatment outcome. Our aim was to compare the reduction of spasticity and the related finger position at rest improvement in post-stroke patients treated with botulinum toxin type A in upper limb muscles using ultrasound guidance and manual needle placement.
  
  
  METHODS
  In a randomized clinical trial, two groups of 15 stroke patients were treated with botulinum toxin type A injections in the wrist and finger flexor muscles of the affected upper limb using ultrasound guidance or manual needle placement. The Modified Ashworth Scale and the finger position at rest were measured at baseline and one month after toxin injections.
  
  
  RESULTS
  After one month of follow-up from toxin injections, the Modified Ashworth Scale and finger position at rest significantly improved in both treatment groups, although these clinical outcomes were significantly better in patients treated under ultrasound guidance than in patients injected using manual needle placement.
  
  
  CONCLUSIONS
  Ultrasound guidance for botulinum toxin type A injections could improve clinical outcome measures better than manual needle placement in post-stroke patients with spasticity.
authors.affiliation: Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia, Italy. Electronic address: andrea.santamato@unifg.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Santamato
authors.affiliation: Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia, Italy.
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Micello
authors.affiliation: Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology of the University of Bari Aldo Moro, "Pia Fondazione Card G. Panico", Tricase, Lecce, Italy; Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy. Electronic address: geriat.dot@geriatria.uniba.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Panza
authors.affiliation: Sector of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fortunato
authors.affiliation: Physical Medicine and Rehabilitation, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Baricich
authors.affiliation: Physical Medicine and Rehabilitation, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Cisari
authors.affiliation: Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy; Geriatrics Unit, Azienda ULSS 16 Padova, S. Antonio Hospital, Padova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pilotto
authors.affiliation: Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology of the University of Bari Aldo Moro, "Pia Fondazione Card G. Panico", Tricase, Lecce, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Logroscino
authors.affiliation: Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Fiore
authors.affiliation: Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ranieri
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005385:Fingers / Q000503:physiopathology; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000187:drug effects; D009339:Needles / Q000706:statistics & numerical data; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods; D014953:Wrist / Q000503:physiopathology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Cerebrovascular disorders; Incobotulinumtoxina; Muscle hypertonia; Ultrasonography