Journal CME March 2025,-PM R - 2024 - Harris - Ultrasound visualization of Botulinum toxin injection Identifying clinical correlates to optimize (1)

PM R - 2024 - Harris - Ultrasound visualization of Botulinum toxin injection Identifying clinical correlates to optimize (1)

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Pdf Summary

The study focuses on optimizing botulinum toxin (BoNT) injections for spasticity management by using ultrasound for guided injections to minimize the risk of injectate leakage. Leakage beyond the targeted muscle can cause unwanted weakness, and ultrasound can help directly visualize the target and detect potential leaks. The research aimed to identify clinical factors associated with leakage, such as muscle size, fibroadipose changes, and injection history.<br /><br />The study was conducted prospectively at an outpatient clinic, involving 54 patients with upper extremity spasticity, primarily with cerebrovascular accidents. Injections were administered into the flexor carpi radialis muscle, and ultrasound was used to capture and analyze the procedure. The main outcome was the visualization of injectate leak on video, which was later correlated with factors like muscle diameter, injectate volume, and fibrotic changes.<br /><br />Results showed a 18.5% leakage rate, with leakage more likely in patients with higher Modified Heckmatt Scale scores, which indicate greater fibroadipose infiltration. No significant relation was found between leakage, injectate volume, and muscle diameter, suggesting that leak risk is more associated with muscle condition rather than injectate amount or muscle size.<br /><br />While ultrasound did not show significant associations with injectate volume, it provided valuable insights into muscle architecture and its role in potential leakage. This study highlights the importance of considering fibroadipose muscle changes during BoNT injections to anticipate leakage and optimize treatment. Future research could target better visualization techniques or study different muscle groups to broaden findings. The study underscores ultrasound's utility in guiding injections to enhance accuracy and outcomes in spasticity management.

Keywords

botulinum toxin

spasticity management

ultrasound guidance

injectate leakage

fibroadipose changes

muscle architecture

Modified Heckmatt Scale

cerebrovascular accidents

flexor carpi radialis

BoNT injections