Contribution of ultrasound to confirm the injection sites of botulinum toxin identified by electrostimulation in the treatment of spasticity of the biceps brachii and brachial muscles.
Dr Sarah CAMPLANa, Dr Vincent BENARDb, Prof François LEROYb
a Service de neuropsychologie et de neuroréhabilitation, Centre Hospitalier Universitaire Vaudois, b Service de MPR, CHU de Caen
Objective: to study the contribution of ultrasound to confirm clinically identified injection points and then identified with electrostimulation.
Type of study: observational, descriptive, prospective.
Material and methods: Fifteen patients having already received botulinum toxin injections were included (30 injected muscles). Two injectors realized the gesture with electrostimulation followed by an echographic examination of the position of the needle. Patients received treatment twice at a distance of at least 3 months. During the second injection, spasticity and GAS (goal attentment scaling) were reassessed before proceeding.
Results: Ultrasound confirmed a concurring needle position in 80% of cases. Three discrepancies were observed in each series, one in one of the two points of the brachii biceps muscle and the other two on one of the two points of the brachial muscle. Spasticity decreased in 60% of cases according to the Tardieu scale and in 40% according to the Ashworth scale. GAS was at zero in 73.3% of cases.
Discussion: This study showed that tracking with muscle electrostimulation afforded less precision than with ultrasound. Ultrasound helped for gesture accuracy and effectiveness. Spasticity decreased more when the location was good. The injection of botulinum toxin into the muscles with electrically stimulated tracking coupled with ultrasound would appear as a complementary technique, the accuracy of the gesture being reinforced by ultrasound and the presence of muscle tissue being confirmed with electrostimulation.
Keywords : spasticity, botulinum toxin, electrostimulation, ultrasound