title: Treatment of atlantoaxial rotatory fixation with botulinum toxin muscle block and manipulation.
abstract: Slippage after reduction of atlantoaxial rotatory fixation (AARF) is usually treated with repeated cervical traction and brace immobilization. To date, no data have been published on the management of muscle spasm during treatment. Here, we describe the case of a 7-year-old girl with AARF for 1 month who visited our hospital for treatment. During physical examination, spasm of the sternocleidomastoid muscle was noted. The patient was treated with manipulative reduction, and slippage after reduction was managed with botulinum spasticity block of the sternocleidomastoid and splenius capitis muscles, and repeated manipulation. Cervical orthosis immobilization with a rehabilitation program of isometric contract-relax exercise for the neck was conducted for 3 months. The subject had full recovery from AARF at 1-year follow-up. This report demonstrates that, in selected cases of slippage after reduction from AARF, conservative management with manipulation under anesthesia is a good method, and the muscle components may play a crucial role in AARF.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taiwan, ROC.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Chun-Jung
authors.initials: CJ
authors.lastname: Chen
authors.forename: Chuan-Mu
authors.initials: CM
authors.lastname: Chen
authors.forename: Su-Lan
authors.initials: SL
authors.lastname: Liao
authors.forename: Shue-Ling
authors.initials: SL
authors.lastname: Raung
authors.forename: Sen-Wei
authors.initials: SW
authors.lastname: Tsai
mesh_terms: D001268:Atlanto-Axial Joint / Q000293:injuries*; D001905:Botulinum Toxins / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000628:therapy*; D008349:Manipulation, Orthopedic / Q000379:methods*; D014103:Torticollis / Q000628:therapy*
chemical_list: D001905:Botulinum Toxins