In-Plane Ultrasound-Guided Botulinum Toxin Injection to Lumbrical and Interosseus Upper Limb Muscles: Technical Report

Abstract

This technical report presents an innovative approach utilizing in-plane ultrasound-guided injections to precisely target the lumbrical and interosseous muscles within the upper limb. The report also elucidates the rationale and advantages of incorporating ultrasound guidance in the administration of Botulinum toxin (BTX) injections, encompassing the real-time visualization of needle trajectory and accurate localization of the target muscle groups while delving into the pertinent anatomical details of these muscles and their significance in diverse neuromuscular conditions. The step-by-step procedure for conducting in-plane ultrasound-guided BTX injections to the lumbrical and interosseous muscles is delineated, emphasizing critical technical considerations and potential pitfalls to be vigilant of during the procedure. Furthermore, the article addresses the significance of selecting appropriate BTX dosages and injection sites based on individual patient presentations and clinical indications. Overall, the in-plane ultrasound-guided BTX injection technique presents a promising approach for providing precise and targeted treatment to the lumbrical and interosseous muscles in the upper limb. It offers clinicians an alternative to injections performed without guidance or out-of-plane ultrasound-guided injections, potentially decreasing the likelihood of complications and enhancing treatment outcomes for patients with a range of neuromuscular conditions. However, further research and comparative studies are necessary to establish the long-term efficacy and safety of this technique, thus confirming its role in clinical practice.

Keywords: botulinum; botulinumtoxin; in-plane; interossei; lumbricals; ultrasound.

Figure 1. In-lane US-guided injection. Insertion point of the needle.

This is the insertion point for the needle in an in-plane ultrasound-guided injection technique for a patient with upper limb spasticity [6]. The insertion point was selected to ensure a parallel ultrasound view of the needle.

Figure 2. Ultrasound appearance of the hand intrinsic muscles.

The white arrow indicates the dorsal interosseous muscle, the red arrow points to the palmar interosseous muscle and the yellow arrow highlights the lumbrical muscle.