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The Elias University Hospital Approach: A Visual Guide to Ultrasound-Guided Botulinum Toxin Injection in Spasticity:

Marius Nicolae Popescu¹, Claudiu Căpeț², Cristina Beiu³

¹Department of Physical and Rehabilitation Medicine, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.

|June 25, 2025

Summary

This guide details ultrasound-guided botulinum toxin type A (BoNT-A) injections for proximal upper limb spasticity. It offers visual anatomy and strategies for precise BoNT-A delivery, enhancing patient outcomes.

Keywords:

botulinum toxin-A injections musculoskeletal ultrasound post-stroke spasticity proximal upper limb muscles ultrasound-guided therapy

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Area of Science:

Neurology
Medical Imaging
Rehabilitation Medicine

Background:

Upper limb spasticity significantly impacts patient function and quality of life.
Botulinum toxin type A (BoNT-A) injections are a key treatment modality for spasticity.
Ultrasound guidance enhances precision and safety in BoNT-A injections.

Purpose of the Study:

To provide a comprehensive visual guide to ultrasound-guided BoNT-A injections for proximal upper limb muscles.
To detail ultrasound anatomy, clinical relevance, and injection techniques for specific proximal upper limb muscles.
To complement previous work on distal upper limb muscles, offering a complete approach to upper limb spasticity management.

Main Methods:

Detailed analysis of ultrasound anatomy for proximal upper limb muscles.
Demonstration of injection strategies using the Elias University Hospital (EUH) model.
Inclusion of high-quality ultrasound images and dynamic videos for procedural clarity.

Main Results:

Structured approach to BoNT-A administration for latissimus dorsi, teres major, subscapularis, pectoralis major, pectoralis minor, deltoid, triceps brachii, biceps brachii, brachialis, and brachioradialis.
Enhanced understanding of scanning techniques and anatomical landmarks.
Visual evidence supporting precise BoNT-A delivery in proximal upper limb muscles.

Conclusions:

Ultrasound-guided BoNT-A injections offer a precise and effective method for managing proximal upper limb spasticity.
This visual guide serves as an essential reference for clinicians seeking to optimize BoNT-A therapy.
The Elias University Hospital approach ensures safety and improved outcomes in spasticity treatment.