Ultrasound-Guided Lateral Approach for Needle Insertion into the Subscapularis for Treatment of Spasticity Dong-wook Rha, MD, PhD, Seung-Ho Han, MD,

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Ultrasound-Guided Lateral Approach for Needle Insertion into the Subscapularis for Treatment of Spasticity Dong-wook Rha, MD, PhD, Seung-Ho Han, MD, PhD, Hee-Jin Kim, DDS, PhD, Sung-Yoon Won, OT, PhD, Sang Chul Lee, MD, PhD Archives of Physical Medicine and Rehabilitation Volume 93, Issue 7, Pages 1147-1152 (July 2012) DOI: 10.1016/j.apmr.2012.02.017 Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 1 The cadaver was positioned lying on 1 side with the examination side up. The shoulder was placed in a flexion and external rotation/abduction position to give the US probe access to the posterior axillary fold. Archives of Physical Medicine and Rehabilitation 2012 93, 1147-1152DOI: (10.1016/j.apmr.2012.02.017) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 2 Schema for the injection technique to the subscapularis. a, line connecting points D and E; A, acromial tip; b and c, lines drawn perpendicular from points F and B to line a; B, lower margin of the glenoid fossa; C, inferior angle; D, midpoint between points A and C; E, midpoint of the spine; F, midpoint between points B and D; G, crossing point between lines a and b; H, crossing point between line a and c. Archives of Physical Medicine and Rehabilitation 2012 93, 1147-1152DOI: (10.1016/j.apmr.2012.02.017) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 3 A transverse US image of the subscapularis muscle below the scapula. The muscle membrane of the subscapularis appears as a hyperechoic band (arrow) and separates the subscapularis from the teres major. Abbreviations: R, rib; S, lateral margin of scapula; SA, serratus anterior. Archives of Physical Medicine and Rehabilitation 2012 93, 1147-1152DOI: (10.1016/j.apmr.2012.02.017) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 4 The needle was inserted into the subscapularis using the US-guided lateral approach. After placing the needle tip (arrow) into the target points, the dye was injected. Abbreviations: SS, subscapularis; TMa, teres major; TMi, teres minor. Archives of Physical Medicine and Rehabilitation 2012 93, 1147-1152DOI: (10.1016/j.apmr.2012.02.017) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 5 Dye from 2 of the 3 injections (solid arrows) was detected within 1.0cm of the motor points of the subscapularis muscle. Dye from 1 of the injections (dashed arrow) did not reach the target. Archives of Physical Medicine and Rehabilitation 2012 93, 1147-1152DOI: (10.1016/j.apmr.2012.02.017) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions