RT Journal
A1 Pearl, Michael L.
T1 Commentary on an Article by Marybeth Ezaki, MD, et al.: “OnabotulinumtoxinA Injection as an Adjunct in the Treatment of Posterior Shoulder Subluxation in Neonatal Brachial Plexus Palsy”
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2010
FD September 15
VO 92
IS 12
SP e17 1
OP 2
DO 10.2106/JBJS.J.00938
UL http://dx.doi.org/10.2106/JBJS.J.00938
AB 
Dr. Ezaki and coauthors bring to the orthopaedic literature the most comprehensive and convincing experience to date demonstrating a role for Botox (onabotulinumtoxinA) injection in the treatment of early internal rotation contractures secondary to birth brachial plexus palsy. The authors are to be congratulated for pushing forward a treatment protocol that was aimed at, and seems to have achieved, a reduced need for more extensive surgical procedures on their patients. What we learn from this study is that Botox injection into the internal rotator muscles of the shoulder and immobilization of the shoulder in a spica cast in external rotation decreases the severity of internal rotation contractures and possibly resultant humeral head and glenoid dysplasia in some children with birth brachial plexus palsy. What remains unclear is whether casting alone might be beneficial and how beneficial this would be. There are also many unanswered questions regarding which children are the best candidates for this intervention in terms of age, severity of contracture and deformity, etc. For those who do not respond to this treatment regimen, might we be expending resources and treatment opportunities that might have been better utilized by other procedures?