Ann Rehabil Med.  2014 Feb;38(1):127-131. 10.5535/arm.2014.38.1.127.

Effects of Botulinum Toxin on Reducing the Co-contraction of Antagonists in Birth Brachial Plexus Palsy

• Shin YB
• Shin MJ
• Chang JH
• Cha YS
• Ko HY

• KMID: 2266551
• DOI: http://doi.org/10.5535/arm.2014.38.1.127

Abstract

Birth brachial plexus palsy (BBPP) is usually caused by plexus traction during difficult delivery. Although the possibility of complete recovery is relatively high, 5% to 25% of BBPP cases result in prolonged and persistent disability. In particular, muscle imbalance and co-contraction around the shoulder and elbow cause abnormal motor performance, osseous deformities, and joint contracture. Physical and occupational therapies have most commonly been used, but these conventional therapeutic strategies have often been inadequate, in managing the residual muscle imbalance and muscle co-contraction. Therefore, we attempted to improve the functional movements, by using botulinum toxin type A, to reduce the abnormal co-contraction of the antagonist muscles.

Keyword

Birth brachial plexus palsy; Obstetric brachial plexus injury; Botulinum toxin type A; Brachial plexus neuropathies

MeSH Terms

Botulinum Toxins*
Botulinum Toxins, Type A
Brachial Plexus Neuropathies
Brachial Plexus*
Congenital Abnormalities
Contracture
Elbow
Joints
Muscles
Occupational Therapy
Paralysis*
Parturition*
Shoulder
Traction
Botulinum Toxins
Botulinum Toxins, Type A

Figure

• 

  Fig. 1 Participant flow chart. BTX, botulinum toxin type A.

• 

  Fig. 2 Two channels surface electromyography of biceps (channel 1) and triceps (channel 2) muscles. (A) Normal contraction pattern of the biceps and triceps muscles during elbow flexion on sound side, before the use of botulinum toxin type A (BTA). (B) The biceps-triceps co-contraction and the pronounced triceps activation during elbow flexion on involved side, before the use of BTA. (C) Reduced triceps co-contraction, 3 weeks after the injection of the BTA in the triceps muscle (only channel 2 visible).

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  Fig. 3 Root mean square changes after botulinum toxin type A injection. (A) Case 1, (B) case 2, (C) case 3, and (D) case 4.

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