Determination of Injection Site in Flexor Digitorum Longus for Effective and Safe Botulinum Toxin Injection

Kim, Hong Geum; Chung, Moonkyung; Song, Dae Heon; Kim, Ju Yong; Sul, Bo Mi; Oh, Chang Hoon; Park, Nam Su

doi:10.5535/arm.2015.39.1.32

Cited by 3 publications

(3 citation statements)

References 39 publications

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“…Their general anatomical measurements showed that 82.5% of the NEPs of the TPM are located 10–30% from the proximal reference point on the reference line, with the needle puncture depth about 3.5 cm (Lee et al, ). Kim et al chose the same reference line and found that the NEP of the FDLM was (46.78 ± 9.65)% distal to the proximal reference point on the reference line (Kim et al, ). However, Yi et al designated the joining line from the lateral malleolus to the fibular head on the body surface as a reference line, and found the NEPs of the TPM, FDLM and FHLM to be (75 ± 3.5)%, (68 ± 5.4)%, and (56 ± 4.5)%, respectively, from the lateral malleolus (Yi et al, ).…”

Section: Discussionmentioning

confidence: 99%

Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg

Zhuo

Zhang

et al. 2017

Clinical Anatomy

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To identify the optimal body surface puncture locations and the depths of nerve entry points (NEPs) in the deep posterior compartment muscles of the leg, 60 lower limbs of thirty adult cadavers were dissected in prone position. A curved line on the skin surface joining the lateral to the medial epicondyles of the femur was taken as a horizontal reference line (H). Another curved line joining the lateral epicondyle of the femur to the lateral malleolus was designated the longitudinal reference line (L). Following dissection, the NEPs were labeled with barium sulfate and then subjected to spiral computed tomography scanning. The projection point of the NEP on the posterior skin surface of the leg was designated P, and the projection in the opposite direction across the transverse plane was designated P'. The intersections of P on H and L were identified as P and P , and their positions and the depth of the NEP on PP' were measured using the Syngo system and expressed as percentages of H, L, and PP'. The P points of the tibial posterior, flexor hallucis longus and flexor digitorum longus muscles were located at 38.10, 46.20, and 55.21% of H, respectively. The P points were located at 25.35, 41.30, and 45.39% of L, respectively. The depths of the NEPs were 49.11, 54.64, and 55.95% of PP', respectively. The accurate location of these NEPs should improve the efficacy and efficiency of chemical neurolysis for treating spasticity of the deep posterior compartment muscles of the leg. Clin. Anat. 30:855-860, 2017. © 2017 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg

Zhuo

Zhang

et al. 2017

Clinical Anatomy

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“…To improve the neurophysiological function of BTX at the motor endplates, an accurate needle position in target areas with a high density of motor endplates is recommended . Physiologically, this location may be one with a high density of neuromuscular junctions (NMJs), and is typically referred to as the innervation zone (IZ) or endplate zone (EZ) . Determination of these zones is possible by surface electromyography (EMG) or neuromuscular electrical stimulation (NMES) .…”

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confidence: 99%

“…3 Physiologically, this location may be one with a high density of neuromuscular junctions (NMJs), 5 and is typically referred to as the innervation zone (IZ) 6 or endplate zone (EZ). 7 Determination of these zones is possible by surface electromyography (EMG) 8,9 or neuromuscular electrical stimulation (NMES). 10,11 The skin area showing the lowest motor threshold for a given electrical current by NMES is defined as the motor point (MP).…”

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confidence: 99%

Anatomical versus functional motor points of selected upper body muscles

et al. 2017

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Mapping the limb muscle motor points for targeted administration of botulinum toxin in the treatment of focal and segmental spasticity

Коваленко

Sinelnikov²,

Shamigulov

et al. 2020

RJTAO

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Spasticity treatment remains an urgent problem of modern neurorehabilitation. The targeted injection of botulinum neurotoxin (BoNT) into the muscle motor points (MPs) is gaining more and more popularity. But there are insufficient data on the position of MPs, while a MP search methodology has not been worked out yet. Most information about MPs has been obtained on cadaveric material using anatomical dissection or Sihler’s staining technique. Clinical data on the targeted injection of BoNT into the MPs are contradictory, which may be due to the inaccurate determination of their position.Objective: to verify upper and lower limb muscle MPs through electromyography (EMG).Patients and methods. Forty healthy volunteers were examined and underwent anthropometric assessment. Upper and lower limb muscle projections were completely scanned using EMG and ultrasound.Results and discussion. The anatomical localization of MPs in the upper and lower limb muscles involved in spasticity patterns was determined. The position of MPs was found to populationally identical, to have a slight deviation associated with the limb length, and to be unrelated to gender, age, and limb dominance. Original tables and maps for limb MP localization were created.Conclusion. The findings can enhance the efficiency of BoNT administration and improve the quality of rehabilitation measures, since the use of reliable information on the position of MPs will allow targeted BoNT injection in the immediate vicinity of the site of biological action. In clinical practice, this opens a window of opportunity for the early initiation of rehabilitation measures aimed at restoring movement.

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Determination of Injection Site in Flexor Digitorum Longus for Effective and Safe Botulinum Toxin Injection

Cited by 3 publications

References 39 publications

Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg

Localization of nerve entry points as targets to block spasticity of the deep posterior compartment muscles of the leg

Anatomical versus functional motor points of selected upper body muscles

Mapping the limb muscle motor points for targeted administration of botulinum toxin in the treatment of focal and segmental spasticity

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