Effects of Ultrasound-Guided Administration of Botulinum Toxin (IncobotulinumtoxinA) in Patients with Lateral Epicondylitis.

How effective and safe are incobotulinumtoxinA injections in adult patients with lateral epicondylitis refractory to other treatments? In this experimental study, ultrasound-guided incobotulinumtoxinA 10⁻30 U/muscle was injected into extensor carpi ulnaris, extensor digiti minimi, extensor digitorum longus and extensor carpi radialis brevis muscles. Pain (visual analogue scale [VAS], 0 to 10 [no pain to severe pain]) and upper-limb functionality (QuickDASH scale, 0 to 100 [best to worst]), assessed at baseline, 1, 3 and 6 months post-treatment, were analysed using repeated-measures analysis of variance (ANOVA) and Tukey post-hoc tests. Secondary analyses stratifying patient population by sex and baseline VAS were performed. Adverse events were reported. Twenty-four patients (mean [standard deviation] age 46.8 years) were included. Compared with baseline, mean VAS and QuickDASH scores improved at all follow-ups (p < 0.001 and p = 0.001, respectively; repeated-measures ANOVA). Secondary analyses revealed significant differences between baseline and all follow-ups in the group with baseline VAS ≥ 6 and in males and females (all p < 0.05, Tukey post-hoc test). No adverse events, except for the expected third finger weakness, were reported. In conclusion, ultrasound-guided incobotulinumtoxinA injections may be an effective treatment for lateral epicondylitis in the appropriate patient population.

Development of the Spanish version of the Spinal Cord Independence Measure version III: cross-cultural adaptation and reliability and validity study.

PURPOSE: To provide a translation and cross-cultural adaptation of the Spinal Cord Independence Measure (SCIM) version III for Spain and to validate the Spanish version of the SCIM III (eSCIM III). PATIENTS AND METHODS: Development of eSCIM III has involved translation, back-translation and assessment of cultural equivalence procedures. eSCIM version III, was administered to 64 patients with spinal cord injury, admitted to our hospital. Investigation of the psychometric characteristics included: (1) study of the inter-rater reliability, (2) internal consistency (Cronbach's α), (3) validation and confirmation of the correlation between eSCIM III and Functional Independence Measure (FIM), and (4) sensitivity to change. RESULTS: The reliability of eSCIM III showed an intra-class coefficient value >0.97 in the different subscales assessed. Internal consistency of eSCIM III was shown by a Cronbach's α value of 0.93. The validity of eSCIM III was confirmed by the close correlation with FIM (r = 0.94, p < 0.0001). The sensitivity to change of eSCIM III was also confirmed. CONCLUSIONS: eSCIM III was found to be culturally equivalent to the original version, as reliability and validity of this tool were demonstrated. It can be used in Spain for functional assessment of patients with spinal cord injury.

[Infiltration of the psoas muscles with botulinum toxin guided by computerised axial tomography: a series of cases]. / Infiltración del psoas con toxina botulínica guiada por tomografía axial computarizada: serie de casos.

AIM: To evaluate the effectiveness and safety of infiltrating the psoas muscle with botulinum toxin guided by computerised tomography (CT) in order to reduce dynamic contracture in bending the hip. PATIENTS AND METHODS: The study involves a series of five children diagnosed with spastic cerebral palsy and bilateral involvement. All the children were able to walk and they presented an attitude on bending the hips and knees consisting in the typical 'crouch gait' together with a dynamic contracture of the hips and knees. They did not present any contraindications for the use of botulinum toxin and their parents gave their consent. Under CT control and anaesthetic sedation, both psoas muscles were infiltrated with a dose of 3 U/kg of body weight; later, both ischiotibial muscles were infiltrated using 3 U/kg doses. The patients were evaluated both prior to and four weeks after infiltration; the muscular range was assessed by means of goniometry, muscular tone was evaluated using the modified Ashworth scale, spasticity was measured using Tardieu's dynamic test and the attitude in bending the hips and knees under a load was assessed by goniometric measurement. Likewise, adverse secondary effects to the puncture or to the use of the toxin were recorded. RESULTS: The five patients reported an improvement in both mobility (with a reduction of tone and contracture) and the posture when standing. CONCLUSIONS: Infiltration of the psoas muscle guided by CT is an effective, safe technique for reducing spasticity in bending the hip, which, if accompanied by infiltration of the ischiotibial muscles, improves the attitude on bending the hip and knee.

Infiltración del psoas con toxina botulínica guiada por tomografía axial computarizada: serie de casos / Infiltration of the psoas muscles with botulinum toxin guided by computerised axial tomography: a series of cases

Objetivo. Evaluar la eficacia y seguridad de la infiltración del psoas con toxina botulínica guiada por tomografía axial computarizada (TAC) en la reducción de la contractura dinámica en la flexión de la cadera. Pacientes y métodos. Serie de cinco niños diagnosticados de parálisis cerebral espástica y afectación bilateral. Todos los niños eran ambulantes, presentaban una actitud en la flexión de las caderas y rodillas con la típica ‘marcha agazapada’, una contractura dinámica de caderas y rodillas, no presentaban contraindicaciones para el uso de toxina botulínica, y sus padres dieron su consentimiento. Bajo control de TAC y sedación anestésica, se infiltraron ambos psoas con una dosis de 3 U/kg de peso; posteriormente, se infiltraron ambos isquiotibiales en dosis de 3 U/kg. Los pacientes fueron evaluados previamente y cuatro semanas después de la infiltración, valorándose el rango muscular mediante goniometría, el tono muscular mediante la escala modificada de Ashworth, la espasticidad mediante el test dinámico de Tardieu, y la actitud en la flexión de las caderas y rodillas en carga mediante medición goniométrica. Igualmente, se registraron efectos adversos secundarios a la punción o al uso de la toxina. Resultados. En los cinco pacientes se produjo una mejora de la movilidad, y una disminución del tono y la contractura, así como de la postura en bipedestación. Conclusiones. La infiltración del psoas guiada por TAC es una técnica efectiva y segura para disminuir la espasticidad en la flexión de la cadera, que, acompañada de la infiltración de los isquiotibiales, mejora la actitud en la flexión de cadera y rodilla (AU)

Aim. To evaluate the effectiveness and safety of infiltrating the psoas muscle with botulinum toxin guided by computerised tomography (CT) in order to reduce dynamic contracture in bending the hip. Patients and methods. The study involves a series of five children diagnosed with spastic cerebral palsy and bilateral involvement. All the children were able to walk and they presented an attitude on bending the hips and knees consisting in the typical ‘crouch gait’ together with a dynamic contracture of the hips and knees. They did not present any contraindications for the use of botulinum toxin and their parents gave their consent. Under CT control and anaesthetic sedation, both psoas muscles were infiltrated with a dose of 3 U/kg of body weight; later, both ischiotibial muscles were infiltrated using 3 U/kg doses. The patients were evaluated both prior to and four weeks after infiltration; the muscular range was assessed by means of goniometry, muscular tone was evaluated using the modified Ashworth scale, spasticity was measured using Tardieu’s dynamic test and the attitude in bending the hips and knees under a load was assessed by goniometric measurement. Likewise, adverse secondary effects to the puncture or to the use of the toxin were recorded. Results. The five patients reported an improvement in both mobility (with a reduction of tone and contracture) and the posture when standing. Conclusions. Infiltration of the psoas muscle guided by CT is an effective, safe technique for reducing spasticity in bending the hip, which, if accompanied by infiltration of the ischiotibial muscles, improves the attitude on bending the hip and knee (AU)