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

Buchanan, Patrick J.; Grossman, John A. I.; Price, Andrew E.; Reddy, Chandan G.; Chopan, Mustafa; Chim, Harvey

doi:10.1177/1558944718760038

Cited by 22 publications

(23 citation statements)

References 18 publications

(84 reference statements)

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“…Although other studies have reported the use of OBTT-A in BPBP patients, very few have reported on its use in infants (Table 1 ). [ 1 , 2 , 12 , 14 – 16 , 21 , 22 ] Our results are similar to that in the literature, but our population tended to be younger (all <6 months of age), had injections before surgery, and had a relatively long follow-up. Arad et al demonstrated sustained clinically useful improvement in 8 children (age range: 6–92 months) after OBTT-A injections to the triceps; however, 75% of the children had prior surgery.…”

Section: Discussionsupporting

confidence: 87%

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Onabotulinum toxin type A injection into the triceps unmasks elbow flexion in infant brachial plexus birth palsy

et al. 2020

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Brachial plexus birth palsy (BPBP) is a neurologic injury that can result in mild to full paralysis of the affected upper extremity. In severe cases, nerve surgery is often performed before age 1 year. Several studies report gains in elbow flexion with onabotulinum toxin type A (OBTT-A) injections to the triceps; however, its use in infants is not widely reported. The purpose of this study is to present our experience using these injections before 6 months of age to therapeutically unmask elbow flexion and diagnostically guide surgical decision making. This is a retrospective observational cohort study. The cohort included infants with BPBP who received OBTT-A injection to the triceps before age 6 months. Indications for the injections include trace elbow flexion and palpable co-contraction of the biceps and triceps. Elbow flexion was evaluated using the Toronto Test score. Therapeutic success was defined as an increase in post-injection scores. These scores were then used diagnostically as an indication for surgery if the infant did not achieve full elbow flexion by 8 months. A treatment algorithm for OBTT-A triceps injection was developed based on all treatment options offered to infants with elbow flexion deficits seen in the clinic. Of the 12 infants that received OBTT-A triceps injections, 10 (83%) had improved Toronto test elbow flexion scores post-injection. Gains in elbow flexion once attained were maintained. Of the 9 OBTT-A infants with at least 2 years follow-up, 4 achieved full elbow flexion without surgery; the remainder after surgery. No complications with OBTT-A injections were noted and patients were followed on average 6 years. The average age at time of injection was 4 months (range: 2–5 months). Compared to other treatments given, OBTT-A infants tended to present with more elbow flexion than the 4 infants requiring immediate surgical intervention and less elbow flexion than the 16 infants treated conservatively. OBTT-A injection to the triceps in infants with BPBP before 6 months of age therapeutically improved elbow flexion and diagnostically guided surgical decisions when full elbow flexion was not achieved by 8 months of age with no known complications.

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Section: Discussionsupporting

confidence: 87%

“…[ 1 , 2 , 12 – 16 , 19 – 22 ] The majority of patients receiving OBTT-A injections to the triceps to unmask biceps function were performed on patients with ages ranging from age 4 months to 13 years, with very few under 1 year of age (Table 1 ). [ 1 , 2 , 12 , 14 – 16 , 21 , 22 ]…”

Section: Introductionmentioning

confidence: 99%

Onabotulinum toxin type A injection into the triceps unmasks elbow flexion in infant brachial plexus birth palsy

et al. 2020

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“…Частота полного восстановления функции верхней конечности относительно высока, однако у 10-30 % пациентов уже в возрасте 2-3 лет вследствие неврологического дефицита возникают выраженные нарушения мышечного баланса и коконтракция мышц, что в дальнейшем приводит к деформации костей и суставов, а также к двигательным нарушениям. Типичными мишенями на верхней конечности являются области плечевого и локтевого суставов [11][12][13][14][15][16][17][18].…”

Section: лекции и обзорыunclassified

“…В связи с наиболее частым повреждением верхнего ствола и подлопаточного нерва конечность принимает положение внутренней ротации в плечевом суставе, разгибания в локтевом суставе и пронации предплечья. Подобное положение конечности является функционально невыгодным для пациента и не обеспечивает выполнение им основных навыков самообслуживания [12]. Неполное восстановление надлопаточного нерва приводит к формированию внутриротационной контрактуры в плечевом суставе вследствие сохранения большой грудной и подлопаточной мышц и возникновения глено-хумеральной дисплазии [12].…”

Section: лекции и обзорыunclassified

“…1) внутриротационная (приводящая) контрактура плечевого сустава; 2) ограничение активного разгибания в локтевом суставе; 3) ограничение активного сгибания в локтевом суставе; 4) пронационная контрактура предплечья [12,30].…”

Section: лекции и обзорыunclassified

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Botulinum therapy using in the complex treatment of children with the result of the brachial plexus intranatal injury (literature review)

Агранович¹

2020

Neuromuscular Diseases

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The incidence of plexus brachial birth injuries consists 0.12 % of births (0.04–0.20 %). Although the possibility of complete recovery is relatively high, 10–30 % patients have secondary deformity and limitation of upper limb function due to muscle imbalance and co-contraction around the shoulder and elbow cause abnormal motor performance, osseous deformities and joint contracture. Botulinum toxin type A injections into targeted muscles in combination with occupation therapy, physiotherapy or operative treatment reduce the abnormal cocontraction of the antagonist muscles and help to restore muscles balance and prevent secondary deformities. The article discuses indications for botulinum injection therapy, target muscles, doses of botulinum toxin A, optimal patient’s age and results of treatment.

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

Lee

Hur

et al. 2023

Clinical Anatomy

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This study aimed to identify ideal sites for botulinum toxin injection by analyzing the intramuscular nerve patterns of the triceps brachii muscles. A modified Sihler's method was applied to the triceps brachii muscle (15 specimens), with long, medial, and lateral heads. The intramuscular arborization areas of the long, medial, and lateral heads of the triceps brachii muscle were measured as a percentage of the total distance from the midpoint of the olecranon (0%) to the anteroinferior point of the acromion (100%), by dividing the medial and lateral parts based on the line connecting the midpoint of the olecranon and the anteroinferior point of the acromion. Intramuscular arborization patterns were observed at the long head at two medial regions, proximally 30%–50% and distally 60%–70%; medial head of 30%–40%; and lateral head of 30%–60%. These results suggest that the treatment of spasticity of the triceps brachii muscles involves botulinum toxin injections in specific areas. The areas corresponding to the areas of maximum arborization are recommended as the most effective and safe points for botulinum toxin injection.

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

Cited by 22 publications

References 18 publications

Onabotulinum toxin type A injection into the triceps unmasks elbow flexion in infant brachial plexus birth palsy

Onabotulinum toxin type A injection into the triceps unmasks elbow flexion in infant brachial plexus birth palsy

Botulinum therapy using in the complex treatment of children with the result of the brachial plexus intranatal injury (literature review)

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

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