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Optimal injection points for the neuromuscular blockade of forearm flexor muscles: a cadaveric study

Roberts, Charlesa; Crystal, Rogera; Eastwood, Deborah M.b

Journal of Pediatric Orthopaedics B: September 2006 - Volume 15 - Issue 5 - p 351-355

Botulinum toxin acts at neuromuscular junctions close to muscle motor points and is used to help manage spastic upper-limb deformities. To develop a system allowing clinicians to identify optimal injection sites by an easily reproducible technique, forearm flexor muscles were dissected in 20 formalin-preserved human limbs. Motor points for flexor carpi ulnaris, flexor carpi radialis, flexor digitorum superficialis and pronator teres were (1) identified, (2) related to a reference grid based on lines (proximal, distal, lateral, medial and diagonals) drawn between forearm anatomical landmarks, and (3) defined in terms of their percentage distances along the established grid lines.

aDepartment of Anatomy, University College London

bThe Royal National Orthopaedic Hospital, London, UK

Correspondence and requests for reprints to Miss D.M. Eastwood, FRCS, The Catterall Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middx HA7 4AP, UK

Tel: +44 208 909 5758; fax: +44 208 954 4566;


© 2006 Lippincott Williams & Wilkins, Inc.