Effective botulinum toxin injection guide for treatment of cervical dystonia

Yi, Kyu Ho; Choi, You–Jin; Cong, Li-Yao; Lee, Kyu‐Lim; Hu, Kyung Seok; Kim, Hee Jin

doi:10.1002/ca.23430

Cited by 41 publications

(42 citation statements)

References 36 publications

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“…Therefore, precise knowledge of the anatomical features of the SA muscle should be considered. In this study, we carried out Sihler's staining, which is a whole mount staining procedure that stains myelin sheaths and is effective in tracing the nerve endings without destroying the nerves 14,[38][39][40]68 . The application of Sihler's staining to the SA muscle will enable an accurate and thorough understanding of the neural distribution.…”

Section: Discussionmentioning

confidence: 99%

“…BoNT blocks neural transmission by stalling the release of acetylcholine at the neuromuscular junction and impedes muscle contraction 12 . In myofascial pain control, BoNT injection is renowned for offering better consequences than oral medications in terms of pain management and functional movement [13][14][15] . Therefore, BoNT is widely used as a treatment option for MPS, especially SAMPS [16][17][18][19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

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Intramuscular Neural Distribution of the Serratus Anterior Muscle: Guidelines to the Injective Method for Treating Myofascial Pain Syndrome

Yi¹,

Lee²,

Seo³

et al. 2021

Preprint

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The serratus anterior muscle is commonly involved in myofascial pain syndrome and is treated with many different injective methods. Currently, there is no definite injection point for the muscle. This study provides an ideal injection point for the serratus anterior muscle considering the intramuscular neural distribution using the whole mount staining method. A modified Sihler method was applied to the serratus anterior muscles (15 specimens). The intramuscular arborization areas were identified in terms of the anterior (100%), middle (50%), posterior axillary line (0%), and from the first to the ninth ribs. The intramuscular neural distribution for the serratus anterior muscle had the largest arborization patterns in the 5th to 9th rib portion between 50% and 70%, and the 1st to 4th rib portion had between 20% and 40%. Clinicians can administer safe and effective treatments with botulinum neurotoxin injections and other types of injections, following the methods in our study. We propose optimal injection sites in relation to the external anatomical line for the frequently injected facial muscles to facilitate the efficiency of botulinum neurotoxin injections. Lastly, these guidelines would assist practice more accurately without the harmful side effects of trigger point injections and botulinum neurotoxin injections.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intramuscular Neural Distribution of the Serratus Anterior Muscle: Guidelines to the Injective Method for Treating Myofascial Pain Syndrome

Yi¹,

Lee²,

Seo³

et al. 2021

Preprint

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show abstract

“…Current practice for BoNT injections is often guided by the middle of the muscle fiber (Childers, 2004). However, according to anatomical studies, arborization patterns are not located in the middle of the muscle fibers, especially when the muscle is not unipennate (Rha et al, 2016; Yi et al, 2016; Yi et al, 2017; Yi, Choi, et al, 2020; Yi, Lee, et al, 2020). BoNT injections should target the acetylcholine receptor of the neuromuscular junction; otherwise, it can spread widely, causing undesired paralysis.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, to maximize the effectiveness and lessen the adverse effects, BoNT must be injected into the arborized areas. Studies have been published for locating the intramuscular arborized areas and guiding the site of injection for BoNT (Rha, Yi, Park, Park, & Kim, 2016; Yi et al, 2016; Yi et al, 2017; Yi, Choi, et al, 2020; Yi, Lee, et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Effective botulinum neurotoxin injection in treating iliopsoas spasticity

Lee

et al. 2020

Clinical Anatomy

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Introduction To detect ideal locations for botulinum toxin (BoNT) injection by exploring the intramuscular nerve arborization of the psoas major and iliacus muscles. Method A modified Sihler's method was performed on the psoas major and iliacus muscles (16 specimens each). Intramuscular nerve arborization was recorded according to the most prominent point of the anterior superior iliac spine (ASIS), the posterior superior iliac spine (PSIS), the lesser trochanter (LT), and the transverse process of the 12th thoracic vertebra. Results Intramuscular nerve arborization of the psoas major muscle was the largest from 1/5 to 3/5 the distance from the transverse process of the 12th thoracic vertebra to the PSIS, and the tendinous portion of the muscle occupied from 3/5 to 5/5 this distance. In terms of the plane of the ASIS, the PSIS, and the LT, the arborization of the iliacus muscle was the largest from 1/5 to 3/5 the horizontal distance and 0 to 1/3, the distance longitudinally, and from 1/5 to 2/5, the horizontal distance and 1/3 to 2/3, the longitudinal distance. Discussion These results suggest that an injection of BoNT to the psoas major and iliacus muscle should be applied in specific areas. Additionally, the posterior approach is an ideal method for targeting only the psoas major because the injection point is above the PSIS. However, when treating both the psoas major and iliacus muscles, the proximal anterior approach is an ideal method according to the arborization patterns.

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“…Studies that explain BoNT injection locations by navigating intramuscular neural distribution with naked eye dissection have limits, such as perceiving minuscule nerves and the likelihood of neural damage [17][18][19][20][21][22][23][24][25][26] . Moreover, earlier studies have pronounced trouble in precisely detecting the tiny nerves 14,27,28 .…”

Section: Introductionmentioning

confidence: 99%

Intramuscular Neural Distribution of the Sartorius Muscles: Treating Spasticity With Botulinum Neurotoxin

Lee

Seo

et al. 2021

Preprint

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This study aimed to detect the idyllic locations for botulinum neurotoxin injection by analyzing the intramuscular neural distributions of the sartorius muscles. A altered Sihler’s staining was conducted on sartorius muscles (15 specimens). The nerve entry points and intramuscular arborization areas were measured as a percentage of the total distance from the most prominent point of the anterior superior iliac spine (0%) to the medial femoral epicondyle (100%). Intramuscular neural distribution were densely detected at 20–40% and 60–80% for the sartorius muscles. The result suggests that the treatment of sartorius muscle spasticity requires botulinum neurotoxin injections in particular locations. These locations, corresponding to the locations of maximum arborization, are suggested as the most safest and effective points for botulinum neurotoxin injection.

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Effective botulinum toxin injection guide for treatment of cervical dystonia

Cited by 41 publications

References 36 publications

Intramuscular Neural Distribution of the Serratus Anterior Muscle: Guidelines to the Injective Method for Treating Myofascial Pain Syndrome

Intramuscular Neural Distribution of the Serratus Anterior Muscle: Guidelines to the Injective Method for Treating Myofascial Pain Syndrome

Effective botulinum neurotoxin injection in treating iliopsoas spasticity

Intramuscular Neural Distribution of the Sartorius Muscles: Treating Spasticity With Botulinum Neurotoxin

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