scholarly journals Ultrasonographic Evaluation of Botulinum Toxin Injection Site for the Medial Approach to Tibialis Posterior Muscle in Chronic Stroke Patients with Spastic Equinovarus Foot: An Observational Study

Toxins ◽  
2017 ◽  
Vol 9 (11) ◽  
pp. 375 ◽  
Author(s):  
Alessandro Picelli ◽  
Alessio Baricich ◽  
Elena Chemello ◽  
Nicola Smania ◽  
Carlo Cisari ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Injection Site ◽  
Botulinum Toxin Injection ◽  
Muscle Thickness ◽  
Chronic Stroke ◽  
Tibialis Posterior ◽  
Anatomical Landmarks ◽  
Echo Intensity ◽  
Stroke Patients ◽  
Medial Approach

The tibialis posterior muscle is a frequent target for injection of botulinum toxin during the management of spastic equinovarus foot in adults with post-stroke spasticity. Although it is deep-seated, the needle insertion into the tibialis posterior muscle is usually performed using anatomical landmarks and safety information obtained from healthy subjects and cadavers. Our aim was to evaluate the botulinum toxin injection site for the medial approach to the tibialis posterior muscle in chronic stroke patients with spastic equinovarus foot. Forty-six patients were evaluated at the affected middle lower leg medial surface with ultrasonography according to the following parameters: tibialis posterior muscle depth, thickness, and echo intensity. As to the spastic tibialis posterior, we found a mean muscle depth of 26.5 mm and a mean muscle thickness of 10.1 mm. Furthermore we observed a median tibialis posterior muscle echo intensity of 3.00 on the Heckmatt scale. The tibialis posterior muscle thickness was found to be inversely associated with its depth (p < 0.001) and echo intensity (p = 0.006). Furthermore, tibialis posterior muscle depth was found to be directly associated with its echo intensity (p = 0.004). Our findings may usefully inform manual needle placement into the tibialis posterior for the botulinum toxin treatment of spastic equinovarus foot in chronic stroke patients.

P1-15-06. The effect of combination of Neuromuscular Electrical Stimulation and botulinum toxin injection in chronic stroke patients

2019 ◽  
Vol 130 (10) ◽  
pp. e213
Author(s):  
Koshiro Haruyama ◽  
Michiyuki Kawakami ◽  
Takuya Nakamura ◽  
Osamu Oshima ◽  
Nanako Hijikata ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Botulinum Toxin ◽  
Botulinum Toxin Injection ◽  
Neuromuscular Electrical Stimulation ◽  
Chronic Stroke ◽  
Stroke Patients

Botulinum toxin injection site localization for the tibialis posterior muscle

2006 ◽  
Vol 15 (6) ◽  
pp. 414-417 ◽  
Author(s):  
Michael J. Oddy ◽  
Christopher Brown ◽  
Rikki Mistry ◽  
Deborah M. Eastwood
Keyword(s):  
Botulinum Toxin ◽  
Injection Site ◽  
Botulinum Toxin Injection ◽  
Tibialis Posterior ◽  
Site Localization

scholarly journals Ultrasonographic Evaluation of Three Approaches for Botulinum Toxin Injection into Tibialis Posterior Muscle in Chronic Stroke Patients with Equinovarus Foot: An Observational Study

Toxins ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 829
Author(s):  
Stefania Spina ◽  
Salvatore Facciorusso ◽  
Chiara Botticelli ◽  
Domenico Intiso ◽  
Maurizio Ranieri ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Subcutaneous Tissue ◽  
Botulinum Toxin Injection ◽  
Botulinum Toxin Type A ◽  
Cross Sectional Area ◽  
Tibialis Posterior ◽  
Sectional Area ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Advantages And Disadvantages

Spastic equinovarus (SEV) foot deformity is commonly observed in patients with post-stroke spasticity. Tibialis posterior (TP) is a common target for botulinum toxin type-A (BoNT-A) injection, as a first-line treatment in non-fixed SEV deformity. For this deep muscle, ultrasonographic guidance is crucial to achieving maximum accuracy for the BoNT-A injection. In current clinical practice, there are three approaches to target the TP: an anterior, a posteromedial, and a posterior. To date, previous studies have failed to identify the best approach for needle insertion into TP. To explore the ultrasonographic characteristics of these approaches, we investigated affected and unaffected legs of 25 stroke patients with SEV treated with BoNT-A. We evaluated the qualitative (echo intensity) and quantitative (muscle depth, muscle thickness, overlying muscle, subcutaneous tissue, cross-sectional area) ultrasound characteristics of the three approaches for TP injection. In our sample, we observed significant differences among almost all the parameters of the three approaches, except for the safety window. Moreover, our analysis showed significant differences in cross-sectional area between treated and untreated. Advantages and disadvantages of each approach were investigated. Our findings can thus provide a suitable reference for clinical settings, especially for novice operators.

Relationship of Quadriceps Muscle Thickness with Motor Paralysis and Muscle Echo Intensity in Post-Stroke Patients

2019 ◽  
Vol 81 (1-2) ◽  
pp. 56-62 ◽  
Author(s):  
Hisashi Maeda ◽  
Ken Imada ◽  
Koji Ishida ◽  
Hiroshi Akima
Keyword(s):  
Muscle Thickness ◽  
Quadriceps Muscle ◽  
Muscle Quality ◽  
Quality Loss ◽  
Echo Intensity ◽  
Stroke Patients ◽  
Post Stroke ◽  
Paretic Limb ◽  
Motor Paralysis ◽  
Relationship Of

Introduction: Quadriceps muscle atrophy and quality loss, defined as an increased ratio of intramuscular fat and/or connective tissue, are often observed especially in the paretic limb of post-stroke patients. This study was performed to examine the relationship of quadriceps muscle thickness (MT) with muscle echo intensity (EI) and the severity of motor paralysis after stroke. Methods: Thirty-six hemiparetic subacute post-stroke patients were enrolled. We examined the MT (index of muscle quantity) and the EI (index of muscle quality) at the anterior mid-thigh in both limbs. We also assessed the Brunnstrom stage (BR stage), subcutaneous adipose tissue thickness, time since stroke, age, body weight, sex, number of medications, and nutritional and inflammation status. Results: The MT in the paretic limb was explained by the BR stage (β = –0.26, p < 0.01), body weight (β = 0.68, p < 0.01), and serum albumin (β = 0.34, p < 0.01), with an adjusted R2 of 0.81. The MT in the non-paretic limb was explained by the muscle EI (β = –0.55, p < 0.01) and age (β = –0.40, p < 0.01), with an adjusted R2 of 0.69. The muscle EI was explained by the MT in the paretic limb (β = –0.34, p < 0.01) and non-paretic limb (β = –0.69, p < 0.01). Conclusions: Our results suggest that motor paralysis, aging, and malnutrition contribute to quadriceps atrophy in post-stroke patients. Moreover, a potential countermeasure to diminish muscle quality loss is maintenance of muscle quantity.

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