Monica Khanna MBBS, FRCR, Presenter: Nothing to Disclose

Sharon Morgans, Abstract Co-Author: Nothing to Disclose

Catherine Barrett BSC, Abstract Co-Author: Nothing to Disclose

Rodger Emery, Abstract Co-Author: Nothing to Disclose

Amanda Walker FRCR, Abstract Co-Author: Nothing to Disclose

To evaluate and describe the use of Ultrasound (US) guided injection of Botulinum toxin A into selected muscles of the shoulder girdle musculature for the treatment of muscle patterning instability, a poorly described condition in the literature.

6 adolescent patients diagnosed by a multidisciplinary team with muscle patterning instability, a rare disorder resulting in recurrent instability and pain of the shoulder, who had failed conservative measures were selected. 3 underwent dynamic US assessment of the shoulder girdle musculature. Muscles demonstrating fasciculation were selected for injection of Botulinum toxin A under US guidance providing direct visualisation of the needle tip and the muscle being injected. Pre and post procedure symptomatic assessment was performed with a continued post procedure multidisciplinary treatment program including input from physiotherapists, psychologists and orthopaedic surgeons.

5 patients (6 shoulders) all female ranging from age 15-30 years, with a mean age of 20.8 years underwent injections of Botulinum toxin A into selected shoulder muscle groups. 3 into pectoralis major were non image guided, 1 into deltoid, 1 into teres major and 1 into latissimus dorsi and teres major were under US guidance. US offers advantages of no electromyographic evaluation, general anaesthetic, low financial impact, low patient stress and accurate needle placement at the site of fasiculations. 3 patients had hyperlax joints and 2 benign joint hypermobility syndrome. All 5 patients suffered long-term symptoms of recurrent instability and pain, 2 with bilateral symptoms and 2 with permanent dislocations. 2 patients had undergone previous surgical stabilization. 3 patients (4 shoulders) reported improvement post injection with good joint congruency and reduction in pain. 1 reported no long term improvement and 1 had improved joint congruency but the shoulder was not fully functional.  

Ultrasound guided injection of Botulinum toxin A into selected muscles of the shoulder girdle for muscle-patterning instability is a newly described procedure, which provides pain relief, reduced instability and advantages over non image guided techniques.  

US guided injection of Botulinum toxin A for shoulder muscle patterning instability is effective in providing pain relief and reducing instability and is advantageous over non image guided techniques.

Khanna, M, Morgans, S, Barrett, C, Emery, R, Walker, A, Ultrasound-guided Injection of Botulinum Toxin in the Treatment of Shoulder Muscle Patterning Instability: Experience in 3 Cases and Its Advantages over Nonimage-guided Techniques.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006727.html