Fig. 6.

Free hand US-guided Botulinum toxin A injection in biceps brachii muscle of a patient with spasticity consequent to stroke. (a) Anterior longitudinal scan over humeral diaphysis (HD) in order to evaluate the thickness of subcutaneous tissue (SC) and biceps (BM) and brachialis (BrM) muscles, and to exclude muscle fibrosis. (b) Anterior transverse scan during needle (arrowhead) insertion. (c) PDUS examination during fluid injection depicts the flow into the muscle. (d) The hyperechoic drug deposit remains evident within biceps muscle after removal of needle.