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

Area of Science:

• Neurology
• Musculoskeletal Medicine
• Medical Imaging

Background:

• Distal lower limb spasticity significantly impacts mobility and quality of life in patients with upper motor neuron lesions.
• Current ultrasound-guided botulinum toxin A (BoNT-A) injection techniques lack comprehensive, muscle-specific visual guidance for the distal lower limb.

Purpose of the Study:

• To provide a detailed, ultrasound-guided manual for BoNT-A injections in ten key distal lower limb muscles.
• To enhance precision in targeting spastic muscles and improve patient outcomes in managing lower limb spasticity.

Main Methods:

• Comprehensive anatomical and sonographic descriptions for gastrocnemius, soleus, tibialis posterior, and other key muscles.
• Integration of osseous landmarks, sonographic cues, dynamic features, and neural arborization zones for injection site selection.
• Utilization of high-resolution ultrasound images and videos alongside practical injection protocols.

Main Results:

• A structured approach correlating sonographic findings with optimal injection zones for precise muscle targeting.
• Addresses common spastic deformities like equinus, varus, and hallux deformities.
• Integrates fascial anatomy and motor-point mapping for effective spasticity management.

Conclusions:

• This guide provides a unified framework for clinicians to effectively manage distal lower limb spasticity using ultrasound-guided BoNT-A injections.
• Improved targeting and management strategies can lead to enhanced gait, posture, and patient autonomy.