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Guideline for Botulinum Toxin Injections in the Effective Treatment of Fibular Spasticity

 You‐Jin Choi  ;  Tae‐Hyeon Cho  ;  Sung‐Yoon Won  ;  Hun‐Mu Yang 
 CLINICAL ANATOMY, Vol.33(3) : 365-369, 2020 
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botulinum toxins ; fibular nerve ; muscle spasticity ; nerve endings ; rehabilitation
This study used a modified Sihler's staining method to analyze the nerve distributions of the fibularis muscle to identify the most effective sites for botulinum toxin injection for fibular spasticity treatment. Ten specimens of the fibularis longus and brevis were obtained bilaterally from five fixed cadavers. The applied method of modified Sihler's staining was designed to reveal the intramuscular nerve distribution of the fibularis muscles. We divided the fibularis muscles into four quarters, which were defined as Sections 1-4 starting from the proximal part of the leg. There were one, two, and three nerve entry points in one (10%), six (60%), and three (30%) of the fibularis longus specimens, respectively, and in four (40%), five (50%), and one (10%) of the fibularis brevis specimens, respectively. We counted the number of nerve endings in each section: 321 and 195 points were identified in the fibularis longus and brevis, respectively. The densities of nerve endings were highest in Section 2 of the fibularis longus (147 of 321, 46%) and in Section 3 of the fibularis brevis (78 of 195, 40%). The landmarks used in this study (the fibular head and lateral malleolus) are easily palpable on the skin's surface, allowing clinicians to target the effective injection site (Section 2) without requiring ultrasound guidance, especially for the fibularis longus.
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1. College of Medicine (의과대학) > Dept. of Anatomy (해부학교실) > 1. Journal Papers
Yonsei Authors
Yang, Hun Mu(양헌무) ORCID logo https://orcid.org/0000-0003-1954-0114
Cho, Tae-Hyeon(조태현) ORCID logo https://orcid.org/0000-0001-7230-620X
Choi, You Jin(최유진) ORCID logo https://orcid.org/0000-0003-3701-2200
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