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Review
. 2017 Dec 28;10(1):18.
doi: 10.3390/toxins10010018.

Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures

Katharine E Alter  1 , Barbara I Karp  2
Affiliations
Review

Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures

Katharine E Alter et al. Toxins (Basel). .

Abstract

Injections of botulinum neurotoxins (BoNTs) are prescribed by clinicians for a variety of disorders that cause over-activity of muscles; glands; pain and other structures. Accurately targeting the structure for injection is one of the principle goals when performing BoNTs procedures. Traditionally; injections have been guided by anatomic landmarks; palpation; range of motion; electromyography or electrical stimulation. Ultrasound (US) based imaging based guidance overcomes some of the limitations of traditional techniques. US and/or US combined with traditional guidance techniques is utilized and or recommended by many expert clinicians; authors and in practice guidelines by professional academies. This article reviews the advantages and disadvantages of available guidance techniques including US as well as technical aspects of US guidance and a focused literature review related to US guidance for chemodenervation procedures including BoNTs injection.

Keywords: anatomic localization; botulinum neurotoxin; botulinum toxin; chemodenervation; electrical stimulation; electromyography; guidance; motor points; ultrasound.

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Conflict of interest statement

Alter has received royalties from Demos Medical Publishing.

Figures

Figure 1
Figure 1
(a) Transverse B-mode image, dDistal 1/3 Arm, anterior/flexor muscles; (b) longiudinal B-mode image, distal 1/3 Arm, anterior/flexor muscles.
Figure 2
Figure 2
(a) Transverse B-mode ultrasound (US) image, distal flexor foream/wrist; (b) longaxis B-mode US image, distal flexor foream/wrist.
Figure 3
Figure 3
B-mode ultrasound image, parotid salivary gland.
Figure 4
Figure 4
Ultrasound transducers.
Figure 5
Figure 5
(a) Transverse B-mode US image, Proximal Thigh; (b) transverse B-mode US image, Interscalene Triangle; (c) transverse B-mode US Image, hand (palmar view); (d) transverse B-mode US image, posterior calf (Distal 1/3).
Figure 5
Figure 5
(a) Transverse B-mode US image, Proximal Thigh; (b) transverse B-mode US image, Interscalene Triangle; (c) transverse B-mode US Image, hand (palmar view); (d) transverse B-mode US image, posterior calf (Distal 1/3).
Figure 6
Figure 6
(a) Long-axis B-mode US image, hand (palmar surface); (b) long-axis B-mode US image, anterior neck; (c) long-axis B-mode US image, flexor forearm.
Figure 6
Figure 6
(a) Long-axis B-mode US image, hand (palmar surface); (b) long-axis B-mode US image, anterior neck; (c) long-axis B-mode US image, flexor forearm.
Figure 7
Figure 7
(a) Longitudinal B-mode US image, inplane injection; (b) transverse B-mode US image, out of plane injection medial gastrocnemius; (c) illustration, out of plane view of needle tip and shaft.
Figure 7
Figure 7
(a) Longitudinal B-mode US image, inplane injection; (b) transverse B-mode US image, out of plane injection medial gastrocnemius; (c) illustration, out of plane view of needle tip and shaft.
Figure 8
Figure 8
(a) Flat angle of needle insertion using an in plane technique, effect on needle visualization. Needle is visualized; (b) steep angle of needle insertion using an in plane technique, effect on needle visualization. Visualization is lost due to anisotropy.
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