Hip Adductor Intramuscular Nerve Distribution Pattern of Children: A Guide for BTX-A Treatment to Muscle Spasticity in Cerebral Palsy

Abstract

To investigate the intramuscular nerve distribution pattern in the hip adductors of children and to precisely locate the injection site for botulinum toxin type A (BTX-A) as a treatment for hip adductor spasticity in children with cerebral palsy. Modified Sihler's whole mount nerve staining technique was employed to observe the distribution of intramuscular nerves in hip adductors of children and to further locate zones where terminal nerves are concentrated. The terminal nerves of the adductor longus appeared in a longitudinal distribution band parallel to the line between the upper 1/3 point of the lateral boundary and the center of the medial boundary. In adductor brevis, the terminal nerves showed a sheet-like distribution with a nerve dense area located in the middle of the muscle belly that extends from the upper-inner region to the lower-outer region. Gracilis showed a dense area of terminal nerves in the middle of the muscle belly, closer to the posterior boundary. In adductor magnus, the dense area of terminal nerves showed a sheet-like distribution in the middle and lower region of the muscle belly. The dense area of terminal nerves in the pectineus was located in the middle of the muscle belly. This study is the first to systematically investigate the intramuscular nerve distribution pattern in the hip adductors. The results indicated that the best targets for BTX-A injection, when treating spasticity, are the dense regions of terminal nerves described above.

An assessment of the variation of the intramuscular innervation of the gracilis muscle, with the aim of determining its neuromuscular compartments

“…The intramuscular innervation of the GM has been the subject of previous studies (An et al, 2016; Fattah et al, 2013; Kumar et al, 1998; Morris & Yang, 1999; Won et al, 2012; Yan et al, 2019; Yu et al, 2010). Yan et al (2019) indicated two groups of nerve branches inside the muscle belly: the first consisting of four or five thin branches heading to the origin, insertion, and anterior margin of the muscle, and the second consisting of eight or nine small branches creating a fan‐shaped distribution toward the posterior muscle boundary. Some of these nerve branches run toward the muscle origin and others toward the insertion.…”

“…The intramuscular innervation of the GM has been the subject of previous studies (An et al, 2016;Fattah et al, 2013;Kumar et al, 1998;Morris & Yang, 1999;Won et al, 2012;Yan et al, 2019;Yu et al, 2010). Yan et al (2019) FFMT is performed by clinicians when restoration of a muscle function is needed.…”

“…The intramuscular innervation of the GM has been the subject of previous studies (An et al, 2016;Fattah et al, 2013;Kumar et al, 1998;Morris & Yang, 1999;Won et al, 2012;Yan et al, 2019;Yu et al, 2010). Yan et al (2019) FFMT is performed by clinicians when restoration of a muscle function is needed. The GM, because of its really precious anatomical features, was used as the first muscle in this surgical procedure (Chwei-Chin Chuang, 2009;Harii et al, 1976;Seal & Stevanovic, 2011).…”

“…The neural supply comes from the anterior branch of the obturator nerve, and its vascularity mainly from the deep femoral artery and medial circumflex femoral artery. The innervation and blood supply of the GM have been described previously (An et al, 2016;Crystal et al, 2005;Dziedzic et al, 2018;Fattah et al, 2013;Kumar et al, 1998;Kwon et al, 2009;Macchi et al, 2008;Magden et al, 2010;McKee et al, 1990;Meyers et al, 2005;Morris & Yang, 1999;Yan et al, 2019;Yu et al, 2010).…”

Sihler's staining of the cutaneous nerves of the leg and its implications for sensory reconstruction

“…Sihler's staining can clearly reveal the details of the entire intramuscular nerve distribution pattern in macroscopic and microscopic specimens (Cho et al, 2019; Yan et al, 2019). Using this method, researchers have successfully demonstrated the cutaneous nerve distribution patterns of the occipital region and trigeminal nerve (Kwon et al, 2018; Li, Zhu, Wu, Wei, & Yang, 2019).…”