Comparing retrospectively the guidance of electromyography and ultrasonography for injecting botulinum toxin TYPE A into the finger and wrist flexor muscles of patients with poststroke hemiplegia and spasticity

Objective: To compare the guidance of electromyography and ultrasonography in poststroke patients who received botulinum toxin type A injection into the spastic finger and wrist flexor muscles. Material and Method: A total of 50 folders of patient with poststroke hemiplegia who received botulinum toxin type A injection into flexor carpi radialis(FCR), flexor carpi ulnaris(FCU), flexor digitorum superficialis(FDS), flexor digitorum profundus muscles, are reviewed retrospectively. Folders divided into two groups as USG and EMG. MAS wrist and fingers, Tardieu grade, Tardieu catch angle, wrist PROM, Fugl-Meyer Assesment of motor recovery of upper extremity, Functional Independence Measure(FIM) and Turkish version of Stroke Impact Scale points are analized within groups before treatment and after 4 week. The changes of these variables from baseline were compared between two groups with different injection techniques. Results: MAS, Tardieu grade, Tardieu catch angle, wrist PROM and Stroke Impact Scale Turkish version improved significantly in both group but FM Assesment of motor recovery of upper extremity improved only in USG group. When the changes of variables from baseline were compared between the two groups, the patients in the USG group performed significantly better than those in the EMG group in wrist PROM. No significant difference was observed between the two groups with regards to other variables. Conclusions: İt has been shown that EMG guidance for performing BT-A injection is as effective as USG guidance. Performing BT-A injection under EMG or USG guidance has positive effects on spasticity, passive motion and quality of life, but not on functional independency. USG guidance is more effective in increasing wrist PROM.