Botulinum Neurotoxin as a Therapeutic Modality in Orthopaedic Surgery: More Than Twenty Years of Experience

Contributions of Neural Tone to In Vivo Passive Muscle–Tendon Unit Biomechanical Properties in a Rat Rotator Cuff Animal Model

“…when stretching a spastic muscle of a patient with cerebral palsy, the therapist often experiences a stiff muscle that resists manipulation). 3,22,36,40 Further, pre-operative injection of BoNT-A facilitates the intra-operative surgical manipulation of the muscle-tendon unit by decreasing stiffness (Table 1) and the elastic component 'A' of Fung's QLV (Table 2). Pre-surgical chemical denervation is a novel approach to modulating the in vivo soft-tissue biomechanics of the muscle-tendon unit and may facilitate the mobilization of scarred, retracted, shortened, and atrophied muscle-tendon units during surgery.…”

“…11 Surgical and rehabilitation experience with patients who have sustained neurological insults, such as cerebral palsy or cerebrovascular accidents, demonstrates that the nervous system influences the passive biomechanical properties of muscle. 3,22,36,40 The purpose of the current study is to use botulinum neurotoxin A (BoNT-A) to examine and quantify in vivo neurological contributions to skeletal muscle tone, which consists of elasticity and viscosity. BoNT-A is a potent, naturally occurring toxin that results in a temporary and reversible muscle paresis through pre-synaptic neurological blockade of acetylcholine release.…”

“…BoNT-A is a potent, naturally occurring toxin that results in a temporary and reversible muscle paresis through pre-synaptic neurological blockade of acetylcholine release. 24,36,40 The present study employs Fung's quasilinear viscoelastic (QLV) model to characterize the load-relaxation behavior of muscle-tendon units in an in vivo animal model system. The use of QLV modeling to help characterize a multi-component, muscle-tendon system in vivo was chosen because of the clinical relevance for tendon repair surgery.…”

Use of anatomic measurement to guide injection of botulinum toxin for the management of chronic lateral epicondylitis: a randomized controlled trial

“…1 Recently, this drug has been used in the management of chronic lateral epicondylitis (tennis el bow). [2][3][4][5] The extensor muscles of the wrist are paralyzed with the aim of releasing tension on the common extensor tendon and causing gradual healing of the epicondylitis.…”

“…3 The most important factor in successfully paralyzing any muscle is the site of injection of the botulinum toxin. 1 Injection at a fixed distance from anatomic landmarks, as was performed in previous clinical trials of botulinum toxin for the management of lateral epicondylitis, [2][3][4][5] would result in inadequate paralysis of the intended muscle. It has been suggested that the extensor digitorum muscle, which is innervated by deep branches of the radial nerve, plays an important role in the development of lateral epicondylitis.…”