Journal CME, February 2024: A practical guide to botulinum neurotoxin treatment of teres major muscle in shoulder spasticity: Intramuscular neural distribution of teres major muscle in cadaver model-A practical guide to botulinum neurotoxin treatment of teres major muscle in shoulder spasticity: Intramuscular neural distribution of teres major muscle in cadaver model

A practical guide to botulinum neurotoxin treatment of teres major muscle in shoulder spasticity: Intramuscular neural distribution of teres major muscle in cadaver model

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Botulinum neurotoxin treatment for shoulder spasticity often targets the teres major muscle, but the optimal injection locations have not been determined. In this study, teres major specimens were taken from cadavers and stained to reveal the neural distribution within the muscle. The muscles were divided into five equal sections, and the density of neural endings in each section was evaluated. It was found that the middle 20% of the muscle had the highest density of intramuscular nerve endings, while the tendinous portion was observed at the ends of the muscle. Based on these findings, the authors suggest that botulinum neurotoxin should be injected into the middle 20% of the teres major muscle to improve effectiveness.<br /><br />Currently, there is no agreed-upon guidance for administering botulinum toxin injections in the teres major muscle. Precise injection location is crucial for optimal treatment outcomes, and studies have shown that injections near areas with a high density of neuromuscular junctions are most effective. The authors used a staining technique called Sihler staining to identify the distribution of intramuscular nerves in the teres major muscle. By staining the muscle samples, they were able to visualize the neural arborization patterns within each section of the muscle.<br /><br />The results of the study showed that the middle 20% of the teres major muscle had the highest density of intramuscular nerve endings, making it the ideal location for botulinum toxin injections. The tendinous portion of the muscle was observed at the ends of the muscle. The authors conclude that their findings provide a valuable anatomical basis for improving the effectiveness of botulinum neurotoxin treatments in the teres major muscle. However, further clinical trials will be necessary to validate the technique. The study was conducted in compliance with ethical guidelines, and the authors express their gratitude to the donors and their families for contributing to anatomical research. The study was supported by the National Research Foundation of Korea.

Keywords

botulinum neurotoxin treatment

shoulder spasticity

teres major muscle

injection locations

neural distribution

intramuscular nerve endings

tendinous portion

botulinum toxin injections

neuromuscular junctions

Sihler staining