Use of Botulinum Toxin Type A in the Management of Neonatal Brachial Plexus Palsy

Michaud, Linda J.; Louden, Emily; Lippert, William C.; Allgier, Allison; Foad, Susan L.; Mehlman, Charles T.

doi:10.1016/j.pmrj.2014.05.002

Cited by 27 publications

(59 citation statements)

References 30 publications

(46 reference statements)

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“…Patients with incomplete medical records or <1-year follow-up were excluded. [5][6][7] Patients with concomitant or prior shoulder surgery, or microsurgery within 8 months, 5 were excluded. Two patients underwent repeat closed reductions and only their initial attempts were included.…”

Section: Methodsmentioning

confidence: 99%

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External Rotation Predicts Outcomes After Closed Glenohumeral Joint Reduction With Botulinum Toxin Type A in Brachial Plexus Birth Palsy

Greenhill

Wissinger

Trionfo

et al. 2018

Journal of Pediatric Orthopaedics

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Section: Methodsmentioning

confidence: 99%

“…4 Few recent studies have investigated outcomes after BTX-A, closed reduction, and spica cast immobilization in children with early posterior shoulder subluxation. [4][5][6] The purpose of this study was to review our experience with this treatment method to report success rates and determine pretreatment predictors of success.…”

mentioning

confidence: 99%

External Rotation Predicts Outcomes After Closed Glenohumeral Joint Reduction With Botulinum Toxin Type A in Brachial Plexus Birth Palsy

Greenhill

Wissinger

Trionfo

et al. 2018

Journal of Pediatric Orthopaedics

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“…One study suggested that BTI might be useful to reduce posterior subluxation or dislocation of the shoulder in babies with BPBI 22. BTI could also improve passive and active shoulder ROM and functional capacity 20 23 24. BTI is a minimally invasive treatment that is well tolerated in young children 25.…”

Section: Introductionmentioning

confidence: 99%

“…BTI is a minimally invasive treatment that is well tolerated in young children 25. When used prior to surgery, it could avert or reduce the complexity of surgical secondary orthopaedic procedures (eg, subscapularis release, latissimus dorsi and teres major transfers) 22 23. Although the results of studies of early BTI for BPBI are encouraging, most studies are retrospective, include small samples and do not have a control group.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of early intramuscular botulinum toxin injections to prevent shoulder deformity in babies with brachial plexus birth injury (POPB-TOX), a randomised controlled trial: study protocol

Pons

Eddi

Gal³

et al. 2019

BMJ Open

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IntroductionIn children with brachial plexus birth injury (BPBI), denervation of the shoulder muscles leads to bony deformity in the first months of life, reducing active and passive range of motion (ROM) and causing activity limitation. The aim of this multicentre randomised controlled trial is to evaluate the effectiveness of botulinum toxin injections (BTI) in the shoulder internal rotator muscles of 12-month-old babies in limiting the progression of posterior subluxation of the glenohumeral joint, compared with a sham procedure mimicking BTI. The secondary aims are to evaluate the effectiveness of BTI in (1) limiting the progression of glenoid retroversion and three-dimensional (3D) deformity and (2) improving shoulder ROM and upper limb function, as well as to confirm the tolerance of BTI.Methods and analysisSixty-two babies with unilateral BPBI and a risk of posterior humeral head subluxation will be included. Only those with at least 7% posterior subluxation of the humeral head compared with the contralateral shoulder on the MRI will be randomised to one of two groups: ‘BTI’ and ‘Sham’. The BTI group will receive BOTOX injections at the age of 12 months in the internal shoulder rotator muscles (8 UI/kg). The sham group will undergo a sham BTI procedure. Both groups will undergo repeated shoulder MRI at 18 months of age to quantify changes in the percentage of posterior migration of the humeral head (primary outcome), glenoid version and 3D bone deformity. Clinical evaluations (passive shoulder ROM, active movement scale) will be carried out at baseline and 15 and 18 months of age. The mini-assisting hand assessment will be rated between 10 and 11 months and at 18 months of age. Adverse events will be recorded at least monthly for each child.Ethics and disseminationFull ethical approval for this study has been obtained. The findings will be disseminated in peer-reviewed publications.Trial registration numberEudraCT: 2015-001402-34 in European Clinical Trial database;NCT03198702in Clinical Trial database; Pre-results.

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“…Therefore, the full extent and pattern of shoulder muscle atrophy in OBPP is not well established. The lack of information related to the pectoralis major (PM) and teres major (TM) is a major deficit when developing treatments for children with OBPP, as these muscles are often targeted for lengthening, transfer procedures 13–17 or botulinum toxin injections 18,19 . Thus, a more complete understanding of the pattern and degree of muscle atrophy across shoulder muscles in patients with OBPP is needed to improve interventional outcomes.…”

Section: Introductionmentioning

confidence: 99%

Shoulder muscle atrophy and its relation to strength loss in obstetrical brachial plexus palsy

Pons

Sheehan

et al. 2017

Clinical Biomechanics

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Background Treatment/prevention of shoulder muscle strength imbalances are major therapeutic goals for children with obstetrical brachial plexus palsy. The study aims were to characterize muscle atrophy in children/adolescents with unilateral obstetrical brachial plexus palsy, to quantify the agonist-antagonist muscle volume balance and the association between muscle volume and strength. Methods Eight boys and four girls (age=12.1, standard deviation=3.3) participated in this case-control study. Three-dimensional magnetic resonance images of both shoulders were acquired. The unimpaired shoulder served as a reference. Volumes of deltoid, pectoralis major, supraspinatus, infraspinatus, teres major, subscapularis were calculated based on 3D models, derived through image segmentation. Maximal isometric torques were collected in six directions. Findings All the major muscles studied were significantly atrophied. The teres major demonstrated the biggest difference in atrophy between groups (51 percentage points), the pectoralis major was the least atrophied (23 percentage points). The muscle volume distribution was significantly different between shoulders. Muscle volume could predict maximal voluntary isometric torques, but the regression coefficients were weaker on the impaired side (72% to 91% of the strength could be predicted in the uninvolved side and 24% to 90% in the involved side and external rotation strength could not be predicted). Interpretation This study demonstrates muscle atrophy varied across all the main shoulder muscles of the glenohumeral joint, leading to significant muscle volume imbalances. The weaker coefficients of determination on the impaired side suggest that other variables may contribute to the loss of strength in addition to atrophy.

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Use of Botulinum Toxin Type A in the Management of Neonatal Brachial Plexus Palsy

Abstract: BoNT-A is an effective adjunct to therapy and surgery in managing muscle imbalance, cocontractions, and contractures in neonatal brachial plexus palsy. Use of BoNT-A can result in averting, modifying, or deferring surgical interventions in a number of affected children.

Cited by 27 publications

References 30 publications

External Rotation Predicts Outcomes After Closed Glenohumeral Joint Reduction With Botulinum Toxin Type A in Brachial Plexus Birth Palsy

External Rotation Predicts Outcomes After Closed Glenohumeral Joint Reduction With Botulinum Toxin Type A in Brachial Plexus Birth Palsy

Effectiveness and safety of early intramuscular botulinum toxin injections to prevent shoulder deformity in babies with brachial plexus birth injury (POPB-TOX), a randomised controlled trial: study protocol

Shoulder muscle atrophy and its relation to strength loss in obstetrical brachial plexus palsy

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