title: Novel approach to the application of botulinum toxin to the flexor digitorum superficialis muscle in acquired brain injury.
abstract: OBJECTIVE
  To determine if the finger flexor mapping technique is useful in the reduction of spasticity when injecting neurotoxin within the flexor digitorum superficialis muscle.
  
  
  METHODS
  Case series of consecutive persons with acquired brain injury with upper limb spasticity.
  
  
  METHODS
  The flexor digitorum superficialis mapping technique was used to determine the optimal location for botulinum toxin A insertion into each belly of the flexor digitorum superficialis. Modified Ashworth Scale (MAS) ratings were recorded pre- and post-flexor digitorum superficialis injection from 17 patients (18 limbs) with upper limb spasticity.
  
  
  RESULTS
  The pre-injection mean MAS score was 3.0 +/- 0.7 and the post-injection mean MAS score was 1.5 +/- 0.9 for this cohort. Using the Wilcoxon matched pairs signed rank test, the mean MAS finger flexor scores decreased significantly ( p < 0.05). No adverse events were noted with the procedure.
  
  
  CONCLUSIONS
  This novel technique appears to be feasible and effective for placement of botulinum toxin in the treatment of finger flexor spasticity. Further studies are warranted to compare this method of administration with other injection approaches for the treatment of finger flexor spasticity.
authors.affiliation: Department of Physical Medicine & Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. muninmc@msx.upmc.edu
authors.forename: Michael C
authors.initials: MC
authors.lastname: Munin
authors.forename: Brinda K
authors.initials: BK
authors.lastname: Navalgund
authors.forename: Donna A
authors.initials: DA
authors.lastname: Levitt
authors.forename: Terry P
authors.initials: TP
authors.lastname: Breisinger
authors.forename: Ross D
authors.initials: RD
authors.lastname: Zafonte
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications*; D005240:Feasibility Studies; D005385:Fingers; D006227:Hand Deformities, Acquired / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A