Botulinum Toxin Injection for Internal Rotation Contractures in Brachial Plexus Birth Palsy. A Minimum 5-Year Prospective Observational Study

Abstract

Level II-prospective comparative study.

The Use of Botulinum Toxin Injection for Brachial Plexus Birth Injuries: A Systematic Review of the Literature

“…Eight articles were identified describing the indication for BTX-A on internal rotation/adduction contracture of the glenohumeral joint. 2,[4][5][6]9,13,14,16 A total of 220 patients were treated with BTX-A within these 8 articles. The BTX-A was injected into the pectoralis muscle and often times in combination with the latissimus dorsi muscle.…”

“…The BTX-A was injected into the pectoralis muscle and often times in combination with the latissimus dorsi muscle. 2,[4][5][6]9,13,14,16 Shin et al performed a prospective case report of 4 patients whose shoulder abduction function was not improved by occupational therapy/physical therapy(OT/ PT) alone. BTX-A was injected intramuscularly into the pectoralis major muscle and functional improvement monitored 1 and 6 months post injection.…”

“…The passive external rotation increased 10 degrees after 3 months and no significant changes were seen after 1 or 5 years. 6 Michaud et al performed BTX-A injection into the latissimus dorsi, pectoralis major, and upper subscapularis muscles followed by OT/PT. Fifty-one patients were included, and the mean age at injection was 30.4 months old.…”

“…Five articles were identified that utilized BTX-A for the treatment of biceps/triceps co-contractures. 2,4,10,13,15 A total of 60 patients with biceps/triceps co-contracture were 4 Case series Level IV Desiato and Risina, 2001 5 Prospective cohort Level III Price et al, 2007 14 Retrospective cohort Level IV Rollnik et al, 2000 15 Retrospective cohort Level IV Duijnisveld et al, 2017 6 Prospective comparative Level III Greenhill et al, 2018 9 Retrospective cohort Level IV Michaud et al, 2014 13 Retrospective cohort Level IV Shin et al, 2014 16 Case report Level V Hierner et al, 2001 11 Retrospective cohort Level IV…”

“…Nonetheless, multiple studies have reported positive improvements in shoulder and elbow motion following the use of botulinum toxin type A (BTX-A) in infants and children with BPBI. 5,6,15 Injecting BTX-A into antagonist muscle groups improves the synergistic muscle balance seen in BPBI.…”