Improving selectivity in neuro-orthopedic assessment using intramuscular motor blocks: a 10-year experience - 06/04/26

Doi : 10.1016/j.rehab.2026.102128

David GASQ ^a,^b,^⁎ , Ambre SAVY ^a, Emmeline MONTANE ^b,^c, Daphnée BRUN ^a, Camille CORMIER ^a,^b

^a Clinique Universitaire du Mouvement, Explorations Fonctionnelles Physiologiques, CHU de Toulouse, Hôpital Purpan, Bâtiment R. Fournet, Place du Dr Baylac, 31059, Toulouse, France

^b Unité ToNIC, UMR 1214, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, France

^c Service de NeuroRéadaptation, CHU de Toulouse, Hôpital Purpan, Bâtiment R. Fournet, Place du Dr Baylac, 31059 Toulouse, France

^⁎ Corresponding author : David GASQ, Clinique Universitaire du Mouvement, Explorations Fonctionnelles Physiologiques, CHU de Toulouse, Hôpital Purpan, Bâtiment R. Fournet 31059 Toulouse Clinique Universitaire du Mouvement, Explorations Fonctionnelles Physiologiques, CHU de Toulouse, Hôpital Purpan Bâtiment R. Fournet Toulouse 31059

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Monday 06 April 2026

Highlights

•	Intramuscular motor blocks are indicated when a perineural blockade is not suitable
•	Ultrasound is essential for performing intramuscular motor blocks
•	Intramuscular motor blocks show higher selectivity than perineural blocks
•	Intramuscular blocks are safe at anesthetic doses below guideline recommendations

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Abstract

Background

Selective intramuscular motor blocks (SIMB) may enhance precision in neuro-orthopedic assessment, but supported data remain limited.

Objectives

To describe technical aspects, indications, and safety profile of SIMB compared to selective extramuscular blocks (SEMB) and truncal nerve blocks in spastic hypertonia management.

Methods

Retrospective monocentric study including 383 participants who received 876 ultrasound-guided motor blocks (truncal, SEMB, or SIMB) in routine care. The volumes and doses of anesthetic have been described. Efficacy and adverse events were compared between SIMB and SEMB.

Results

SIMB achieved comparable effectiveness to SEMB with a better selectivity (i.e., less diffusion to non-targeted muscles; 11% vs. 54%; p=10-5; odds ratio[IC95] = 10.0[4.3 to 23.3]). Using doses of anesthetic remaining within French guidelines, SIMB has not shown any safety issues.

Conclusion

SIMB is a safe and precise approach for targeted assessment of spastic hypertonia. Technical description is provided to optimize practice in neuro-orthopedics.

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Keywords : Nerve Block, Ultrasonography, Brain Injuries, Muscle Spasticity, Safety, Selectivity