Objective: The injection of Incobotulinum toxin type A associated with physical therapy may improve the kinematics of flexion and extension of the elbow after obstetrical brachial plexus lesion.

Background: Brachial plexus birth palsy (BPBP) is an upper extremity paralysis that occurs during the childbirth due to traction of the brachial plexus. The most common location of injury is at Erb’s point. The incidence is 0.4 to 4 per 1000 live birth. Approximately 20 per 100 of children afflicted will have residual neurological deficits and persistent disabilities. In particular, even when a successful reinnervation is occurred, spontaneous or post surgical reconstruction, muscular imbalance and co-contraction agonist/antagonist around shoulder and elbow cause abnormal motor performance.

Methods: We study efficacy of IncobotulinumtoxinA type A (Xeomin®) and physical therapy in a sixteen girl with biceps/triceps co-contraction to improve the functional movements of elbow. After 1 (t1) and 3 (t2) months we performed physical and clinical examination (passive range of motion, pROM), miometric (Myoton®) evaluation (to perform objectively muscle tone) and EMG studies (amplitude of motor units at rest, MUAP)

Results: We demonstrated an improving of pROM (t0=140º, t1=180º and t2= 175º), tone (biceps: t0=25,1, t1=20,3 and t2= 20,2, triceps: t0=26,4, t1=20,7 and t2=21,1) and MUAP (biceps: t0=897 µV, t1=321 µV and t2=401 µV, triceps: t0=901 µV, t1=401 µV and t2=422 µV).

Conclusions: This study demonstrated Incobotulinum toxin type A injection and physical therapy improved co-contraction biceps/triceps and permitted an optimal and successful kinematics of elbow flexion and extension after brachial plexus birth palsy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/incobotulinum-toxin-type-a-for-the-treatment-of-biceps-triceps-co-contraction-due-to-obstetrical-brachial-plexus-lesion/