Ultrasound-guided injection of botulinum toxin A in the treatment of iliopsoas spasticity

Abstract

Purpose: Intramuscular injection of botulinum toxin A (BTX-A) is a common treatment for iliopsoas muscle spasticity, but it is not easy to position the needle in this muscle without guidance. In this paper we describe an ultrasound-guided technique for the intramuscular injection of BTX-A to treat spasticity of the iliopsoas muscle. Its effectiveness was assessed in 10 patients.

Method and materials: The ultrasound-guided technique for BTX-A injection was used on 10 patients. The needle was inserted into the muscle belly at an angle of 45° along the longitudinal axis of the muscle when allowed by patient's condition.

Results: In all cases, the iliopsoas muscle was easily identified and both the iliac and psoas components were assessed. Introduction of the needle and drug injection were entirely carried out under ultrasonographic guidance. The procedure was successful in all patients, even in those with a high-grade spasticity, and general anesthesia was not required.

Conclusions: This ultrasound-guided technique allows accurate guidance for the injection of BTX-A, and it can be considered as an alternate supportive therapy in patients with spasticity and dystonia.

Keywords: Botulinum A toxin; Cerebral palsy; Iliopsoas muscle; Injection; Interventional ultrasonography.

Figures

Fig. 1

Ultrasonographic image obtained with a linear probe (12–5 MHz). The needle (arrows) has been inserted into the psoas muscle (asterisk). F = femoral head.

Fig. 2

Ultrasonographic image obtained with a convex probe (5–2 MHz). The needle (arrows) has been inserted into the psoas muscle (asterisk). F = femoral head.