Accuracy of Manual Needle Placement for Gastrocnemius Muscle in Children With Cerebral Palsy Checked Against Ultrasonography

Eun Joo Yang, Dong wook Rha, Jun Ki Yoo, Eun Sook Park

Research output: Contribution to journalArticle

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Yang EJ, Rha D, Yoo JK, Park ES. Accuracy of manual needle placement for gastrocnemius muscle in children with cerebral palsy checked against ultrasonography. Objective: 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). Design: Prospective clinical study. Setting: University-affiliated hospital. Participants: A total of 272 injections in GCMs of 39 children with spastic CP who were scheduled to receive BTX-A injections in GCMs. Intervention: Not applicable. Main Outcome Measures: The accuracy of manual needle placement was checked against ultrasonography. Results: 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 (≥4y, 78.1%). For GM, accuracy in both younger and older age groups was good (>90%). Conclusions: 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.

Original languageEnglish
Pages (from-to)741-744
Number of pages4
JournalArchives of Physical Medicine and Rehabilitation
Issue number5
StatePublished - 28 Apr 2009


  • Botulinum toxins
  • Cerebral palsy
  • Gastrocnemius muscle
  • Rehabilitation

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