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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.


  •  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


  • 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


  • 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.

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    Sierra Summit is the ideal solution for Chemodenervation, EMG, EPs, NCS, Ultrasound, and Electrodiagnostics in Urology.

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