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

Abstract

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.