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BOTULINUM TOXIN A IN THE UPPER LIMB IN CEREBRAL PALSY
Author(s) -
Johnstone B. R.,
Coombs C.,
McCombe D.,
Duncan J.
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_3.x
Subject(s) - medicine , muscle contracture , wrist , splints , cerebral palsy , thumb , flexor carpi ulnaris , elbow , contracture , tendon , tenotomy , surgery , upper limb , botulinum toxin , intrinsics , palsy , anesthesia , physical medicine and rehabilitation , ulnar nerve , alternative medicine , pathology , parallel computing , computer science
Purpose To evaluate patients with cerebral palsy treated with botulinum toxin A injections to assist with the management of contracted muscles and joints as well as co‐contraction. Methods Since 1998, 40 limbs have been treated. The average age was 14 years (range 4 to 33 years) and the average dose given was 107 units (range 50 to 200 units). Digital flexors were injected in 26 limbs, elbow flexors in 18, wrist flexors in 17, thumb adductors in 13, pronator teres in 9, intrinsics in 3, shoulder abductors in 2 and ECU in one limb. All patients were injected under a general anaesthetic, allowing for an assessment of fixed contractures. Padded plaster casts were applied, putting the injected muscles on full stretch before the reversal of anaesthesia and were maintained for approximately 3 weeks. Thermoplastic splits were then wore 23 hrs per day for a further three weeks. Splints were serially modified to achieve progressively more extension as the flexion contractures were corrected. Simultaneous surgical procedures such as tendon lengthening and transfers were performed in 14 limbs. Results The results in the elbow flexors were disappointing. The finger, thumb and wrist flexors have responded extremely well, despite fixed flexion deformities being documented under anaesthesia in the majority of patients. Conclusion It is estimated that the muscle bellies have been elongated by 3 to 4 cm either by the lengthening of, or addition to the sarcomeres. The results in these patients are vastly superior to that which could be obtained surgically.