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Related Concept Videos

Arteries of the Upper Limbs01:12

Arteries of the Upper Limbs

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The subclavian artery transitions into the axillary artery as it exits the chest and enters the axillary region. This artery is critical for supplying blood to the shoulder area, including the head of the humerus, through the humeral circumflex arteries. As the vessel continues into the upper arm or brachium, it becomes the brachial artery. This artery plays a key role in vascularizing the brachial region and bifurcates at the elbow into several branches. These branches include the deep...
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Veins of Upper Limbs01:17

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The human circulatory system, a marvel of biological engineering, is a complex network of vessels that transport blood throughout the body. Among these, the veins responsible for carrying blood from the upper limbs are divided into two categories: deep and superficial.
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Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin01:26

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Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
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Bones of the Upper Limb: Humerus01:19

Bones of the Upper Limb: Humerus

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The upper limb consists of the arm, forearm, wrist, and hand bones. The humerus is the single bone of the upper arm region. Proximally, it has a large, spherical, smooth head that articulates with the glenoid cavity of the scapula to form the glenohumeral or shoulder joint. The margin of the head is the anatomical neck, a residual epiphyseal plate. Laterally it extends to form bony projections called the greater tubercle and the lesser tubercle. Next to the tubercles is the surgical neck, a...
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Bones of the Upper Limb: Ulna01:15

Bones of the Upper Limb: Ulna

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The ulna and radius are parallel bones of the antebrachium or the forearm. The ulna lies medially and consists of a bony tip called the olecranon process at its proximal end. This hook-like projection articulates with the olecranon fossa of the humerus and forms the "hinged" ulnohumeral part of the elbow joint. This joint facilitates forearm extension and flexion while preventing its hyperextension. Similarly, the coronoid process, another bony projection on the proximal/anterior side...
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Bones of the Upper Limb: Radius01:09

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The radius is longer of the two bones that make up the human antebrachium or forearm. At the proximal end, the radius articulates with the capitulum of the humerus and the radial notch of the ulna to form the elbow joint. At the distal end, the radius articulates with the ulna via the ulnar notch, forming the distal radioulnar joint. Distally, the radius also attaches to the carpal wrist bones (scaphoid and lunate) to form the radiocarpal joint.
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Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
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Does botulinum toxin treatment improve upper limb active function?

Jonathan Levy1, Franco Molteni2, Giovanni Cannaviello2

  • 1Department of Physical and Rehabilitation Medicine, Raymond Poincaré Teaching Hospital, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; UMR1179, Neuromuscular handicap, Inserm-University of Versailles-St-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France; Fondation Garches, Raymond-Poincaré Hospital, 92380 Garches, France.

Annals of Physical and Rehabilitation Medicine
|July 1, 2018
PubMed
Summary
This summary is machine-generated.

Botulinum toxin (BT) injections can improve upper-limb spasticity after stroke, but functional gains are inconsistent. Further research is needed to optimize treatment and assess long-term effects.

Keywords:
Botulinum toxinOutcomeRehabilitationSpasticityStrokeUpper limb

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Area of Science:

  • Neurorehabilitation
  • Movement Disorders
  • Clinical Neurology

Background:

  • Central nervous system lesions, particularly stroke, frequently cause upper-limb spasticity, leading to significant impairment and disability.
  • Botulinum toxin (BT) injections offer focal relief for spasticity, but their efficacy in improving upper-limb function remains debated.

Purpose of the Study:

  • To evaluate the functional effects of BT treatment for upper-limb spasticity.
  • To identify limitations in current research methodologies for demonstrating these effects.
  • To propose directions for future clinical trials.

Main Methods:

  • A non-systematic narrative review of MEDLINE and Cochrane databases.
  • Included trials, reviews, and meta-analyses focusing on BT injections for stroke-related upper-limb spasticity.
  • Article selection based on authors' expertise.

Main Results:

  • Therapeutic targets often focused on impairment and passive function, which were more frequently achieved than active function or participation goals.
  • Meta-analyses indicated no to mild effect sizes for upper-limb functional improvement.
  • Studies failed to demonstrate enhanced use of the paretic upper limb in daily activities post-BT injection.

Conclusions:

  • While BT injections improve kinematic parameters related to impairment and passive function, a clear link to improved upper-limb activity is not established.
  • Potential reasons for limited functional gains include underlying muscle weakness, inadequate patient selection methods, short follow-up periods, and the need for adjunctive therapies.
  • Future trials should consider patient selection, longer-term follow-up, and the integration of rehabilitation programs to maximize functional outcomes.