Electromyographic control of botulinum toxin a injections in the upper extremities in patients with spasticity of various etiology

Abstract

BTA injections under EMG-control in upper limb spasticity patients may improve the treatment efficacy.

A practical guide to botulinum neurotoxin treatment of teres major muscle in shoulder spasticity: Intramuscular neural distribution of teres major muscle in cadaver model

“…1 An expert consensus has proposed a patient-centered approach to treating spastic shoulder by identifying activities limited by the occurrence and targeting the muscles involved in those activities. 21 Obtaining optimal results from neurotoxin injection into the shoulder muscles requires a thorough understanding of shoulder anatomy, particularly for muscles that are not superficial. 22 Various techniques for visualizing and controlling the injections have been used to improve effectiveness, including procedural guidance with ultrasound, electromyography, electrical stimulation, and, computed tomography.…”

“…Electromyographic assistance is recommended for injections into small or hard-to-reach muscles of the upper limb or in difficult situations. 21,23 One of the benefits of precise neurotoxin delivery is that smaller doses can be directly targeted at the appropriate area, thus reducing the risk of antibody development that would decrease effectiveness over time. 24,25 Knowledge of where the greatest density of nerve endings is located within the teres major may allow delivery of lower doses and greater effectiveness of the neurotoxin.…”

“…In most cases, it is sufficient to inject only the pectoralis major and teres major as the primary treatment 1 . An expert consensus has proposed a patient‐centered approach to treating spastic shoulder by identifying activities limited by the occurrence and targeting the muscles involved in those activities 21 …”

“…Studies have shown that anatomical landmarks alone are not sufficient for such injections and that use of ultrasound, electrical stimulation, and electromyography improves injection accuracy and treatment efficacy. Electromyographic assistance is recommended for injections into small or hard‐to‐reach muscles of the upper limb or in difficult situations 21,23 . One of the benefits of precise neurotoxin delivery is that smaller doses can be directly targeted at the appropriate area, thus reducing the risk of antibody development that would decrease effectiveness over time 24,25 .…”