Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography.

Abstract

To investigate the accuracy of manual needle placement into gastrocnemius muscle (GCM) for botulinum toxin type A (BTX-A) injection in children with spastic cerebral palsy (CP). Prospective clinical study. University-affiliated hospital. A total of 272 injections in GCMs of 39 children with spastic CP who were scheduled to receive BTX-A injections in GCMs. Not applicable. The accuracy of manual needle placement was checked against ultrasonography. The needle was accurately inserted into GCM muscles in 78.7% of cases. Accuracy was 92.6% into gastrocnemius medialis (GM) and 64.7% into gastrocnemuis lateralis (GL). Muscle thickness at the needle insertion site was significantly thinner in GL than GM. Accuracy of GL in the younger age group (<4y, 57.6%) was lower than in the older age group (> or =4y, 78.1%). For GM, accuracy in both younger and older age groups was good (>90%). Injection of the toxin into GCMs through the use of anatomic landmark was acceptable in GM, but not acceptable in GL, especially in young children.