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Chemodenervation Procedures

Accurately target structures and avoid other tissues in the injection path with Sierra Summit EMG and ultrasound needle guidance for chemodenervation procedures

Cadwell is dedicated to proactively contributing toward the advancement and promotion of Neuromuscular and Diagnostic Ultrasound.

Our fully integrated EMG/US diagnostic solution, and the development of dedicated ultrasound-focused features, is designed to help you help others even more efficiently in the future. Sierra Summit and its fully integrated ultrasound are powerful tools for your chemodenervation procedures.

Instrumented Guidance

EMG with Ultrasound

Combining electromyography with ultrasound imaging helps precisely locate a target while providing muscle activity information and assisting with motor point localization. Patients with complex postures associated with cervical or limb dystonia may be helped by this combined diagnostic technique.

EMG with E-Stim and Ultrasound

Adding electrical stimulation helps precisely locate targets, and helps place the needle in the target muscle or adjacent to the target nerve for motor point localization or nerve blocks. Diagnostic, neurolytic and anesthetic nerve blocks or motor point blocks are typical use cases for this combined technique. Ultrasound helps accurately insert and adjust the needle in target muscles.

EMG

Provides auditory and visual feedback of muscle activity
Helps identify muscles and muscle activity contributing to posture or position
Can assist with motor point localization

Electrical Stimulation

Provides visible feedback of muscle contraction in the target muscle
May be more effective than EMG in patients with Upper Motor Neuron Syndromes
Can assist with motor point localization

Ultrasound

Precisely localizes muscle position, depth, and size
Real-time visualization of the needle, target, and structures to avoid
Real-time visualization of injectate within the target
Cheaper and easier to administer than Fluoroscopy, CT, or MRI

Clinical indications for ultrasound-guided needle injections include:

Muscle Over-Activity (MoA) or Imbalance

Bladder detrusor over-activity in patients with neurologic conditions*
Blepharospasm*
Bruxism
Cervical Dystonia*
Dystonic Tremor
Essential Tremor
Focal Limb Dystonia
Lower Limb Spasticity, Adults and Pediatrics >2*
Overactive Bladder
Palatal Tremor
Segmental Myoclonus
Schwartz-Jampel Syndrome
Strabismus*
Task Tics
Upper Limb Spasticity, adults*
Upper Motor Neuron Syndromes
Vocal Cord Dysfunction

Neuro-Secretory Disorders

Frey Syndrome (Gustatory Sweating)
Palmar Hyperhidrosis
Plantar Hyperhidrosis
Primary axillary hyperhidrosis*
Sialorrhea

Urologic and Gynecologic

Bladder Detrusor Over-activity in Patients with Neurologic Conditions*
Bladder Outlet Obstruction
Bladder Spasms and Pain
Overactive Bladder*
Sphincter Dyssenergy
Urge Incontinence

Gastrointestinal

Achalasia
Rectal Fissure

Pain Conditions

Cerebral Palsy postoperative pain and spasms
Chronic Migraine*
Cervical Dystonia pain associations
Lateral Epicondylitis
Lateral Epicondylosis
Occipital Neuralgia
Piriformis Syndrome
Plantar Fasciitis
Total Knee Arthroplasty postoperative pain
Upper Motor Neuron Syndrome pain associations

* FDA Approved Indications as of November, 2017. Cited from Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures (2018) by Katharine E. Alter and Barbara I. Karp. Click here for the full article.

Ultrasound provides real-time neuromuscular visualization

Dynamic visualization
Ability to see moving tissue
Ability to see vascular flow with Doppler imaging
Protect target and surrounding soft tissue structures in diagnostic and therapeutic needle guidance procedures
Enhance safety and accuracy in needle procedures

Ultrasound is a safe, portable, and low-cost diagnostic imaging technique

No ionizing radiation
Can be used with metallic implants
No claustrophobia, as with other imaging modalities
No restrictions or known adverse effects
Instant feedback of results

Botulinum Neurotoxins (BoNTs)

Many disorders that cause pain and over-activity of muscles, glands, and other structures may be treated by injections of botulinum neurotoxins (BoNTs). Traditionally guided by clinical examination and anatomic landmarks, the accuracy and safety of these injections has been dramatically improved upon with ultrasound.

Ultrasound helps visualize and select muscles or other structures for targeting, accurately localizes the injection target to enhance effectiveness, and minimizes the potential risks and side effects. The goals are to accurately place the needle within the target structure, avoid structures in the needle path, and avoid structures adjacent to or behind the target structure. Anatomic structures, EMG, electrical stimulation, image-based guidance like ultrasound, and motor endplate targeting all help achieve these goals. Direct and continuous ultrasound enables the clinician to redirect the needle to avoid nerves, vessels, tendons or organs on the path to the target. Color Doppler and Power Doppler help determine flow in vessels in the path to the target. Along with EMG and electrical stimulation, ultrasound is a cost-effective, accessible imaging method.