Distribution of the intramuscular innervation of the triceps brachii: Clinical importance in the treatment of spasticity with botulinum neurotoxin

Yi, Kyu‐Ho; Lee, Ji‐Hyun; Hur, Hye‐Won; Lee, Hyung‐Jin; Choi, You–Jin; Kim, Hee‐Jin

doi:10.1002/ca.24004

Cited by 16 publications

(15 citation statements)

References 49 publications

(62 reference statements)

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“…Additionally, our results are restricted to limb spasticity and cannot be generalized for spasticity in axial as well as head/neck muscles or other entities such as dystonia, in which BoNT injections are also applied [27][28][29]. It should also be noted that the authors of the included studies performed manual needle placement based on conventional injection points rather than injections based on intramuscular patterns of the nerve distribution as suggested for some limb muscles [82,83]. Further, network meta-analyses have some limitations, including a higher heterogeneity compared to pairwise meta-analyses as well as compromise of consistency, if direct and indirect evidence deviate [84,85].…”

Section: Limitationsmentioning

confidence: 89%

A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity

Asimakidou

Sidiropoulos

2023

Toxins

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Accurate targeting of overactive muscles is fundamental for successful botulinum neurotoxin (BoNT) injections in the treatment of spasticity. The necessity of instrumented guidance and the superiority of one or more guidance techniques are ambiguous. Here, we sought to investigate if guided BoNT injections lead to a better clinical outcome in adults with limb spasticity compared to non-guided injections. We also aimed to elucidate the hierarchy of common guidance techniques including electromyography, electrostimulation, manual needle placement and ultrasound. To this end, we conducted a Bayesian network meta-analysis and systematic review with 245 patients using the MetaInsight software, R and the Cochrane Review Manager. Our study provided, for the first time, quantitative evidence supporting the superiority of guided BoNT injections over the non-guided ones. The hierarchy comprised ultrasound on the first level, electrostimulation on the second, electromyography on the third and manual needle placement on the last level. The difference between ultrasound and electrostimulation was minor and, thus, appropriate contextualization is essential for decision making. Taken together, guided BoNT injections based on ultrasound and electrostimulation performed by experienced practitioners lead to a better clinical outcome within the first month post-injection in adults with limb spasticity. In the present study, ultrasound performed slightly better, but large-scale trials should shed more light on which modality is superior.

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Section: Limitationsmentioning

confidence: 89%

A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity

Asimakidou

Sidiropoulos

2023

Toxins

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“…Second, it is a retrospective analysis of a single clinician, which may limit applicability and generalization of findings. Third, the study is inherent in its nature as a real-world clinical practice, in which toxin is administered by relying on conventional injection points, rather than on observed intramuscular patterns of nerve distribution [ 41 , 42 ], and in which muscle contracture is evaluated clinically, and not measured with instrumental devices (e.g., magnetic resonance imaging and ultrasound).…”

Section: Discussionmentioning

confidence: 99%

Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief

Trompetto

Marinelli

Mori

et al. 2023

Toxins

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By blocking the release of neurotransmitters, botulinum toxin A (BoNT-A) is an effective treatment for muscle over-activity and pain in stroke patients. BoNT-A has also been reported to increase passive range of motion (p-ROM), the decrease of which is mainly due to muscle shortening (i.e., muscle contracture). Although the mechanism of action of BoNT-A on p-ROM is far from understood, pain relief may be hypothesized to play a role. To test this hypothesis, a retrospective investigation of p-ROM and pain was conducted in post-stroke patients treated with BoNT-A for upper limb hypertonia. Among 70 stroke patients enrolled in the study, muscle tone (Modified Ashworth Scale), pathological postures, p-ROM, and pain during p-ROM assessment (Numeric Rating Scale, NRS) were investigated in elbow flexors (48 patients) and in finger flexors (64 patients), just before and 3–6 weeks after BoNT-A treatment. Before BoNT-A treatment, pathological postures of elbow flexion were found in all patients but one. A decreased elbow p-ROM was found in 18 patients (38%). Patients with decreased p-ROM had higher pain-NRS scores (5.08 ± 1.96, with a pain score ≥8 in 11% of cases) than patients with normal p-ROM (0.57 ± 1.36) (p < 0.001). Similarly, pathological postures of finger flexion were found in all patients but two. A decreased finger p-ROM was found in 14 patients (22%). Pain was more intense in the 14 patients with decreased p-ROM (8.43 ± 1.74, with a pain score ≥ 8 in 86% of cases) than in the 50 patients with normal p-ROM (0.98 ± 1.89) (p < 0.001). After BoNT-A treatment, muscle tone, pathological postures, and pain decreased in both elbow and finger flexors. In contrast, p-ROM increased only in finger flexors. The study discusses that pain plays a pivotal role in the increase in p-ROM observed after BoNT-A treatment.

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“…Age-related transformations in the neck can involve various alterations, including the accumulation of submental fat, skin looseness causing the loss of the cervicomental angle, bone loss, and compromised neck contours resulting from jowl formation [16][17][18][19][20][21]. Various substances such as botulinum neurotoxin, dermal fillers, and skin boosters are employed in the realm of aesthetics to eliminate wrinkles [9,10,[22][23][24][25][26][27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Retrospective Study of Horizontal Neckline Correction Using Absorbable Braided Polydioxanone Threads

Yi,

Kim,

Kim

et al. 2023

Korean Association For Laser Dernatology And Trichology

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Background and ObjectivesHorizontal neck lines are a common aesthetic problem but limited treatment options exist and not have been conducted study with polydioxanonebarbed thread. Polydioxanone-barbed threads introduced braided fine threads design, which works as a template for attraction of the regenerative factors and for cells' migration and proliferation. The purpose of this study was to estimate the outcomes of simultaneous additional application of braided type polydioxanone-barbed threads. Materials and MethodsThe retrospective case series of 4 women (35, 42, 46, and 49 years old) from February 2022 to July 2022 included adult patients receiving polydioxanone-barbed thread to treat horizontal neck wrinkles. Patient were followed up after 8 weeks. Were analyzed and significant improvement in wrinkle intensity, as assessed by Horizontal Neck Wrinkle Severity Scale, was observed after 8 weeks. ResultsThe horizontal neck line were analyzed and had significant improvement in wrinkle intensity, as assessed by Horizontal Neck Wrinkle Severity Scale, was observed at week 8 and remained statistically significant. Patient GAIS (90-100%) and physician GAIS (100%) were both excellent. ConclusionSubdermal treatment of polydioxanone-barbed threads of horizontal neck line is safe and effective for treating horizontal neck wrinkles with no Tyndall effect were observed.

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Distribution of the intramuscular innervation of the triceps brachii: Clinical importance in the treatment of spasticity with botulinum neurotoxin

Cited by 16 publications

References 49 publications

A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity

A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity

Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief

Retrospective Study of Horizontal Neckline Correction Using Absorbable Braided Polydioxanone Threads

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