Botulinum Neurotoxin as a Therapeutic Modality in Orthopaedic Surgery: More Than Twenty Years of Experience by Thorsten M. Seyler, Beth P. Smith, David.

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MANUAL RESISTANCE FOR UPPER LIMB

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Botulinum Neurotoxin as a Therapeutic Modality in Orthopaedic Surgery: More Than Twenty Years of Experience by Thorsten M. Seyler, Beth P. Smith, David R. Marker, Jianjun Ma, Jian Shen, Tom L. Smith, Michael A. Mont, Kat Kolaski, and L. Andrew Koman J Bone Joint Surg Am Volume 90(Supplement 4): November 1, 2008 ©2008 by The Journal of Bone and Joint Surgery, Inc.

Thorsten M. Seyler et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Thorsten M. Seyler et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Some muscles, such as the latissimus dorsi and pectoralis major, require multiple injection sites due to the diffuse localization of neuromuscular junctions. Thorsten M. Seyler et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

The iliacus and psoas major muscles may be injected through an anterior approach with the aid of either ultrasound or electromyographic guidance or through a posterior approach with the aid of computed tomographic guidance. Thorsten M. Seyler et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Needle placement may be confirmed by passive range of motion; however, this technique requires anesthesia, except with very cooperative patients. Thorsten M. Seyler et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

The most common patterns of spasticity observed in pediatric patients with cerebral palsy include both the upper extremity (internal rotation of the shoulder, elbow flexion, forearm pronation, wrist and finger flexion, and thumb-in-palm) and lower extremity... Thorsten M. Seyler et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

With regard to muscle force generation, intramuscular BoNT-A injections resulted in a 75% decrease in the force of twitch contractions compared with the values on the contralateral control side at one week and a >50% decrease at one month after tendon repai... Thorsten M. Seyler et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.

Similar to the findings for twitch contractions, tetanic contractions in the BoNT-A group decreased to 25% of the values on the control side at one week after injection and remained <40% of the values on the control side during the first month. Thorsten M. Seyler et al. J Bone Joint Surg Am 2008;90: ©2008 by The Journal of Bone and Joint Surgery, Inc.