Motor Points for the Neuromuscular Blockade of the Subscapularis Muscle

Harrison, T; Sadnicka, Anna; Eastwood, Deborah M.

doi:10.1016/j.apmr.2006.12.031

Cited by 15 publications

(12 citation statements)

References 16 publications

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“…However, these techniques also do not indicate the NMJ injection site accurately. Various articles describe the muscle motor point (MP) as the BTX injection site (Shaari and Sanders, 1993;Harrison et al, 2007) Anatomically, the MP corresponds to the site where nerves enter muscles (Seidel et al, 1996;Park et al, 2007) Operationally, the MP is the site where the greater muscle contraction with a minimal ES intensity is achieved (Lee et al, 2012;American Association of Electrodiagnostic Medicine, 2001) The location of the MP determined with ES has a high interindividual variability (Botter et al, 2011). A term that is often confused with the MP is the innervation zone (Masuda and Sadoyama, 1991;Saitou et al, 2000) (IZ); this last mentioned corresponds to the anatomical site where the NMJs of a muscle are located.…”

Section: Introductionmentioning

confidence: 99%

Differences between motor point and innervation zone locations in the biceps brachii. An exploratory consideration for the treatment of spasticity with botulinum toxin

Guzmán-Venegas¹,

Araneda²,

Silvestre³

2014

Journal of Electromyography and Kinesiology

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Section: Introductionmentioning

confidence: 99%

Differences between motor point and innervation zone locations in the biceps brachii. An exploratory consideration for the treatment of spasticity with botulinum toxin

Guzmán-Venegas¹,

Araneda²,

Silvestre³

2014

Journal of Electromyography and Kinesiology

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“…This makes it difficult to determine the point at which to situate the electrode for NMES. Harrison et al 10) reported a median value of 5 motor branches in their research on 20 subscapularis muscles and reported site clustering of the MPs, which can be a good candidate for electrode placement. In this study, we also found that about 68% of all MPs were concentrated within the proximal segment of the FH-LM line.…”

Section: Discussionmentioning

confidence: 99%

“…In NMES, 2 surface electrodes are usually used for electric stimulation, and it is recommended that for efficient stimulation 1 electrode is placed over the motor point (MP) of the muscle and the other is placed in an arbitrary position on the same muscle 6) . The MP has been defined as the location where the motor branch enters the muscle belly 1,2,[7][8][9][10][11][12] , and motor endplates have been shown to cluster around this point [10][11][12][13] . It is believed that the MP has a lower surface electrical stimulation threshold than other sites on the same muscle 14,15) .…”

Section: Introductionmentioning

confidence: 99%

Anatomical Consideration of the Motor Point Location of the Tibialis Anterior Muscle for effective Neuromuscular Electrical Stimulation

et al. 2011

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Abstract.[Purpose] We attempted to locate the motor points (MPs) of the tibialis anterior muscle (TA) for more effective neuromuscular electrical stimulation (NMES).[Subjects] We dissected 16 legs from 12 cadavers.[Methods] Branches of the deep peroneal nerve were traced to their entry into TA (MPs). We defined the FH-LM line connecting the fibular head to the lateral malleolus and the pFH-LM perpendicular to the FH-LM lines that ran through each MP. The distance from the fibular head to MPs projected on the FH-LM line was measured. On the pFH-LM line, the width of TA and the distance from the lateral edge of TA to each MP were measured. The location of each MP was expressed as a percentage of total length of the FH-LM line and of TA width, respectively.[Results] The median number of MPs was 8 per cadaver. About 68% of all MPs were located within the proximal one-third of the FH-LM line. The average location of the thickest motor branch MP was 4.2 cm (13.9 %) on the FH-LM line and 0.9 cm (33.5 %) medial from the lateral edge of TA. [Conclusion] This data should enable more effective NMES.

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“…16 Botulinum toxin injection is currently a popular treatment modality for spasticity, 17 but reports are limited on how to inject it into the subscapularis muscle. 6 Furthermore, it is not approved to use for shoulder spasticity in Japan. Subscapularis motor point block for spastic shoulder pain is reported in patients with stroke.…”

Section: Discussionmentioning

confidence: 99%

“…When the subscapularis muscle suffer from upper motor neuron lesions, it becomes spastic and because of its spasticity usually overwhelms the relative weakness of the rest of the rotator cuff muscles, internal rotation and adduction contracture of the shoulder joint with associated pain occurs. 6,7 This can lead to the reduced external rotation and insufficient acromial elevation and potential tendon impingement. 1 Therefore, subscapularis motor point block can potentially be effective to remedy spastic shoulder pain in patients with CCI, but reports have been so far limited to patients with stroke.…”

Section: Introductionmentioning

confidence: 99%

Subscapularis motor point block for spastic shoulders in patients with cervical cord injury

2008

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Study design: Case series. Objectve: The objective was to study the effect of phenol blocks to the motor points of the subscapularis muscle in patients with cervical cord injury (CCI). Setting: Spinal cord injury units of a national hospital in Tokyo. Methods: The participants were seven patients with traumatic CCI, mean age 55.8 years (SD4.0), whose injury level were at the fifth cervical level and the American Spinal Injury Association (ASIA) impairment scale was A in 2, C in 1 and D in 4. They were at least 5 months post-acute injury, and complained of pain and limited range of motion (ROM) of their shoulder joint that were unresponsive to usual rehabilitative interventions and medications. Before and after the phenol block to the motor points of the subscapularis muscle, we compared passive and active ROM of the shoulder (flexion, abduction and external rotation), spasticity of the subscapularis as assessed with the modified Ashworth scale, pain as evaluated with a visual analog scale, and eating item of the Functional Independence Measure. Results: There were significant improvements in passive ROM in flexion (23.71), abduction (19.41) and external rotation (16.81; Po0.05). Visual analog scale for shoulder pain was reduced from 6.0 to 3.4 (Po0.05). The modified Ashworth scale for shoulder spasticity, however, did not significantly change. The eating Functional Independence Measure item score improved significantly (Po0.05). Conclusions: This study suggests that subscapularis motor point block for pain and limited ROM with spastic shoulder is a useful technique in patients with CCI.

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Motor Points for the Neuromuscular Blockade of the Subscapularis Muscle

Cited by 15 publications

References 16 publications

Differences between motor point and innervation zone locations in the biceps brachii. An exploratory consideration for the treatment of spasticity with botulinum toxin

Differences between motor point and innervation zone locations in the biceps brachii. An exploratory consideration for the treatment of spasticity with botulinum toxin

Anatomical Consideration of the Motor Point Location of the Tibialis Anterior Muscle for effective Neuromuscular Electrical Stimulation

Subscapularis motor point block for spastic shoulders in patients with cervical cord injury

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