Abstract
To investigate the intramuscular nerve distribution pattern in the hip adductors of children and to precisely locate the injection site for botulinum toxin type A (BTX-A) as a treatment for hip adductor spasticity in children with cerebral palsy. Modified Sihler's whole mount nerve staining technique was employed to observe the distribution of intramuscular nerves in hip adductors of children and to further locate zones where terminal nerves are concentrated. The terminal nerves of the adductor longus appeared in a longitudinal distribution band parallel to the line between the upper 1/3 point of the lateral boundary and the center of the medial boundary. In adductor brevis, the terminal nerves showed a sheet-like distribution with a nerve dense area located in the middle of the muscle belly that extends from the upper-inner region to the lower-outer region. Gracilis showed a dense area of terminal nerves in the middle of the muscle belly, closer to the posterior boundary. In adductor magnus, the dense area of terminal nerves showed a sheet-like distribution in the middle and lower region of the muscle belly. The dense area of terminal nerves in the pectineus was located in the middle of the muscle belly. This study is the first to systematically investigate the intramuscular nerve distribution pattern in the hip adductors. The results indicated that the best targets for BTX-A injection, when treating spasticity, are the dense regions of terminal nerves described above.
Highlights
Cerebral palsy (CP) is a syndrome caused by non-progressive brain injuries and developmental defects during pregnancy and infancy
We aim to provide more precise anatomical locations for botulinum toxin type A (BTX-A) injection and to improve the treatment of hip adductor spasticity in children with cerebral palsy
We systematically investigated the distribution of intramuscular nerves and dense areas of terminal nerves in the hip adductors of children
Summary
Cerebral palsy (CP) is a syndrome caused by non-progressive brain injuries and developmental defects during pregnancy and infancy. The primary manifestations of this syndrome are dyskinesia and abnormal posture [1]. With developments in perinatal medicine, the diagnosis of cerebral palsy has been increasing. The incidence of the disease among live births is 2.11–3.1% [1,2,3]. The most common type of cerebral palsy is spastic cerebral palsy, which comprises ∼78– 80% of all cases [4, 5]. Spasticity is the primary factor that causes disabilities in children, and affects their psychological and physical development [6]. An effective treatment for muscle spasticity caused by cerebral palsy is a pressing issue
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