2024 Workshop Handout Bundle-W51A Neuromuscular US Anatomy Review for Cranio Cervical BoNT Chemodenervation Procedures Alter

W51A Neuromuscular US Anatomy Review for Cranio Cervical BoNT Chemodenervation Procedures Alter

Pdf Summary

The document is a detailed presentation by Katharine E. Alter, MD, on the neuromuscular ultrasound (US) anatomy review for cranio-cervical Botulinum Toxin (BoNT) chemodenervation procedures, shared at the 2024 AANEM Annual Meeting. It covers comprehensive anatomy and clinical guidelines for effectively administering BoNT in conditions such as various forms of dystonia (cervical, blepharospasm, oromandibular, lingual), upper motor neuron syndromes, and congenital torticollis. <br /><br />Dr. Alter begins by disclosing financial ties with Demos Medical Publishing, Gulf Coast Ultrasound, Catalyst Medical, and Cleveland Clinic Foundation. She outlines the objectives of the presentation, which include reviewing conditions treated with BoNT, understanding the functional head and neck anatomy, discussing guidance options for BoNT procedures, and demonstrating US scanning for craniocervical muscles.<br /><br />The presentation goes into detail about the importance of planning for optimal BoNT treatment outcomes, encompassing pre-procedural, procedural, and post-procedural steps. Key muscles and anatomical structures are highlighted for different dystonic conditions, with a focus on recognizing symptomatic patterns and movements to enable precise targeting and injection of BoNT.<br /><br />The inclusion of ultrasound is emphasized as a vital tool for precise targeting of muscles, demonstrating muscle identification through pattern recognition, and needle guidance while avoiding critical structures such as vessels and nerves. Combined usage of ultrasound and electromyography (EMG) further enhances procedural accuracy and efficacy.<br /><br />Several anatomical caveats are discussed, identifying prime movers, secondary movers, synergists, and compensatory muscles involved in different cranio-cervical movements and postures. Practical examples are provided to illustrate this complex interplay, alongside detailed US images for the identification of specific muscle structures like the sternocleidomastoid, scalenes, and others.<br /><br />Finally, attendees are encouraged to provide feedback and claim their educational credits through the AANEM app, enhancing future meetings and educational content.

Keywords

neuromuscular ultrasound

cranio-cervical

Botulinum Toxin

dystonia

upper motor neuron syndromes

congenital torticollis

muscle identification

ultrasound guidance

electromyography

AANEM Annual Meeting