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BOTULINUM TOXIN A IN OBSTETRIC BRACHIAL PLEXUS PALSY
Author(s) -
Johnstone B. R.,
McCombe D.,
Coombs C.,
Britt K.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04120_2.x
Subject(s) - medicine , brachial plexus , biceps , subluxation , botulinum toxin , palsy , surgery , elbow , pathology , alternative medicine
Purpose To evaluate children with obstetric brachial plexus palsy treated with botulinum toxin A (Botox)injections to assist with the management of contracted muscles and joints as well as co‐contraction. Methods Since September 2004, 20 children have been treated. The median age at treatment was 2.1 years (range 7 months to 11 years). As experience was gained, the total dose of Botox increased from 4 to 10 units per kg. Results 12 patients were treated primarily for restriction of passive external rotation at the shoulder at an average age of 24 months (range 7 to 42 months). This group had the most impressive gains which became apparent within a week of injection. There was a high level of parental satisfaction with an improvement in passive range and increased ease of physiotherapy. Six had excellent and 4 had good results. The two patients who had little improvement had clear indications for surgery. Seven (58%) of these 12 patients went on to have a repeat injection , in 2 cases with a higher dose, aiming to achieve further gains. Five patients were treated for co‐contraction of the latissimus dorsi and/or teres major were aged 8 months and from 8 to 11 years. They reported minor gains.All five patients who had triceps injections had improved elbow flexion. One patient had an over active biceps injected with minor benefit. Conclusion It is hoped that persistent physiotherapy assisted by botulinum toxin A injections targeting internal rotators can reduce gleno‐humoral joint dysplasia, posterior subluxation and the need for open procedures. Shoulder subluxation identified by ultrasound should be further imaged with CT or MRI and be considered for an open procedure.