Article

OBJECTIVE: To evaluate functional outcomes and the impact on surgical
interventions after the use of botulinum neurotoxin type A (BoNT-A) for muscle
imbalance, cocontractions, or contractures with neonatal brachial plexus palsy.
DESIGN: A retrospective cohort study. SETTING: A brachial plexus center in a
tertiary children's hospital. PARTICIPANTS: Fifty-nine patients with neonatal
brachial plexus palsy (75 injection procedures, 91 muscles and/or muscle groups)
received BoNT-A injections (mean age at injection, 36.2 months; range, 6-123
months; 31 boys; 30 right-sided injuries, 28 left-sided injuries, 1 bilateral
injury). METHODS: Data collected retrospectively from medical records, from
procedure notes and clinic visits before BoNT-A use, at </=6 months follow-up
(BoNT-A active [BA]) and at >/=7 months follow-up (BoNT-A not active [BNA])
included demographics, injection indication, side, and site(s), previous surgical
history, occupational therapy and/or physical therapy plan, and outcome
measurements. MAIN OUTCOME MEASUREMENTS: Outcomes assessed before and after
injections included active and passive range of motion, Mallet and Toronto
scores, parent comments about arm function, preinjection surgical considerations,
and postinjection surgical history. RESULTS: Injection procedures included 51 to
shoulder internal rotators, 15 triceps, 15 pronator teres, 9 biceps, and 1 flexor
carpi ulnaris. Active and passive shoulder external rotation (SER) range of
motion improved after shoulder internal rotator injections (P = .0003 and P =
.002, respectively), as did Mallet scores with BA; the latter were sustained with
BNA. Surgical intervention was averted, modified, or deferred after BoNT-A in 45%
(n = 20) under surgical consideration before BoNT-A. Active elbow flexion
improved in 67% (P = .005), sustained BNA (P = .004) after triceps injections; 2
of 7 patients averted surgery. Active supination improved with BA (P = .002),
with gains sustained BNA (P = .016). Passive elbow extension improved after
biceps injections by an average 17 degrees (P = .004) BA, although not sustained
BNA. CONCLUSIONS: BoNT-A is an effective adjunct to therapy and surgery in
managing muscle imbalance, cocontractions, and contractures in neonatal brachial
plexus palsy. Use of BoNT-A can result in averting, modifying, or deferring
surgical interventions in a number of affected children.
CI - Copyright (c) 2014 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS