Botulinum toxin type A as an adjunct to the surgical treatment of the medial rotation deformity of the shoulder in birth injuries of the brachial plexus

We retrospectively reviewed 26 patients who underwent reconstruction of the shoulder for a medial rotation contracture after birth injury of the brachial plexus. Of these, 13 patients with a mean age of 5.8 years (2.8 to 12.9) received an injection of botulinum toxin type A into the pectoralis major...

Full description

Saved in:
Bibliographic Details
Published in:Journal of bone and joint surgery. British volume Vol. 89; no. 3; p. 327
Main Authors: Price, A E, Ditaranto, P, Yaylali, I, Tidwell, M A, Grossman, J A I
Format: Journal Article
Language:English
Published: England 01.03.2007
Subjects:
Birth Injuries - complications
Botulinum Toxins, Type A - administration & dosage
Brachial Plexus - injuries
Child
Child, Preschool
Combined Modality Therapy - methods
Female
Humans
Injections, Intramuscular
Male
Neuromuscular Agents - administration & dosage
Retrospective Studies
Rotation
Shoulder Joint - abnormalities
Shoulder Joint - surgery
Treatment Outcome
ISSN:2044-5377, 2044-5377
Online Access:Get more information
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We retrospectively reviewed 26 patients who underwent reconstruction of the shoulder for a medial rotation contracture after birth injury of the brachial plexus. Of these, 13 patients with a mean age of 5.8 years (2.8 to 12.9) received an injection of botulinum toxin type A into the pectoralis major as a surgical adjunct. They were matched with 13 patients with a mean age of 4.0 years (1.9 to 7.2) who underwent an identical operation before the introduction of botulinum toxin therapy to our unit. Pre-operatively, there was no significant difference (p = 0.093) in the modified Gilbert shoulder scores for the two groups. Post-operatively, the patients who received the botulinum toxin had significantly better Gilbert shoulder scores (p = 0.012) at a mean follow-up of three years (1.5 to 9.8). It appears that botulinum toxin type A produces benefits which are sustained beyond the period for which the toxin is recognised to be active. We suggest that by temporarily weakening some of the power of medial rotation, afferent signals to the brain are reduced and cortical recruitment for the injured nerves is improved.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:2044-5377
2044-5377
DOI:10.1302/0301-620X.89B3.17797