**3.14 Lumbricals**

These are small muscles, that may be injected with sound anatomical knowledge, surface landmarks, or the US-guided. For the first lumbrical, the point marks the distal one-third and proximal two-thirds junction of the second metacarpal (radial side). At this, it lies just radial to this point. First, palpate the muscle by doing metacarpal flexion with distal joints in extension. Once palpated, inject at this point. Similarly, all others can be injected (**Figure 23**).

#### **Figure 23.**

*Lumbricals: plus denotes the entry point for the first lumbrical (1st lumbrical), line represents the radial border of the 1st index metacarpal.*

*Anatomical Surface Guided Techniques for Botulinum Toxin Injection in Spastic Cerebral… DOI: http://dx.doi.org/10.5772/intechopen.107200*
