{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T14:26:13Z","timestamp":1790259973300,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,9,6]],"date-time":"2016-09-06T00:00:00Z","timestamp":1473120000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007819","name":"Allergan","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007819","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Anatomy"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Botulinum Toxin A has been the main treatment for spasticity since the beginning of the 1990s. Surprisingly, there is still no consensus regarding injection parameters or, importantly, how to determine which muscles to target to improve specific functions. The aim of this study was to develop a systematic approach to determine this, using the example of the arm flexion pattern. We first determined anatomical landmarks for selective motor block of the brachialis nerve, using 20 forearms from 10 fresh cadavers in Ecole Europ\u00e9enne de Chirurgie and a university\u2010based dissection centre, Paris, France. We then carried out selective blocks of the motor nerves to the brachialis, brachioradialis and biceps brachii in patients with stroke with an arm flexion pattern, in a University Rehabilitation Hospital, Garches, France. We measured: the resting angle of the elbow angle in standing (manual goniometer), active and passive range of extension, and spasticity using the Held and Tardieu and the Modified Ashworth scales. Range of passive elbow extension was also measured with the shoulder in 90\u00b0 of flexion. The resting angle of the elbow in standing decreased by 35.0\u00b0 (from 87.6\u00a0\u00b1\u00a023.7 to 52.6\u00a0\u00b1\u00a024.2\u00b0) with inhibition of brachialis, by a further 3.9\u00b0 (from 52.6\u00a0\u00b1\u00a024.2 to 48.7\u00a0\u00b1\u00a023.7\u00b0) with inhibition of brachioradialis and a further 14.5\u00b0 (from 48.7\u00a0\u00b1\u00a023.7to 34.2\u00a0\u00b1\u00a020.7\u00b0) with inhibition of biceps brachii. These results were consistent with the clinical evaluation of passive elbow range of motion with the shoulder at 90\u00b0. Sequential blocking of the nerves to the three main elbow flexors revealed that the muscle that limited elbow extension the most, was brachialis. This muscle should be the main target to improve the arm flexion pattern. These results show that it is important not simply to inject the most superficial or powerful muscles to treat a spastic deformity. A comprehensive assessment is required. The strategy proposed in this paper should increase the effectiveness of botulinum toxin injections by ensuring that the relevant muscles are targeted.<\/jats:p>","DOI":"10.1111\/joa.12538","type":"journal-article","created":{"date-parts":[[2016,9,6]],"date-time":"2016-09-06T02:33:56Z","timestamp":1473129236000},"page":"106-116","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Successive motor nerve blocks to identify the muscles causing a spasticity pattern: example of the arm flexion pattern"],"prefix":"10.1111","volume":"230","author":[{"given":"F.","family":"Genet","sequence":"first","affiliation":[{"name":"Service de M\u00e9decine Physique et de R\u00e9adaptation H\u00f4pital Raymond Poincar\u00e9 Garches France"},{"name":"\u2018End:icap\u2019 U1179 INSERM UFR des Sciences de la Sant\u00e9 \u2013 Simone Veil Universit\u00e9 Versailles Saint Quentin en Yvelines Montigny le Bretonneux France"},{"name":"Ecole Europ\u00e9enne de Chirurgie (EEC) Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Schnitzler","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Physique et de R\u00e9adaptation H\u00f4pital Raymond Poincar\u00e9 Garches France"},{"name":"Ecole Europ\u00e9enne de Chirurgie (EEC) Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Droz\u2010Bartholet","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Physique et de R\u00e9adaptation CHRU Besan\u00e7on Besan\u00e7on Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Salga","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Physique et de R\u00e9adaptation H\u00f4pital Raymond Poincar\u00e9 Garches France"},{"name":"\u2018End:icap\u2019 U1179 INSERM UFR des Sciences de la Sant\u00e9 \u2013 Simone Veil Universit\u00e9 Versailles Saint Quentin en Yvelines Montigny le Bretonneux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Tatu","sequence":"additional","affiliation":[{"name":"Laboratoire d'anatomie UFR SMP Universit\u00e9 Bourgogne\/Franche\u2010Comt\u00e9 Besan\u00e7on Cedex France"},{"name":"Service d'Explorations et Pathologies Neuro\u2010musculaires CHRU Besan\u00e7on Besan\u00e7on Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Debaud","sequence":"additional","affiliation":[{"name":"\u2018End:icap\u2019 U1179 INSERM UFR des Sciences de la Sant\u00e9 \u2013 Simone Veil Universit\u00e9 Versailles Saint Quentin en Yvelines Montigny le Bretonneux France"},{"name":"Service de Chirurgie Orthop\u00e9dique H\u00f4pital Europ\u00e9en Georges Pompidou Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Denormandie","sequence":"additional","affiliation":[{"name":"\u2018End:icap\u2019 U1179 INSERM UFR des Sciences de la Sant\u00e9 \u2013 Simone Veil Universit\u00e9 Versailles Saint Quentin en Yvelines Montigny le Bretonneux France"},{"name":"Ecole Europ\u00e9enne de Chirurgie (EEC) Paris France"},{"name":"Service de Chirurgie Orthop\u00e9dique H\u00f4pital Raymond Poincar\u00e9 Garches France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Parratte","sequence":"additional","affiliation":[{"name":"Ecole Europ\u00e9enne de Chirurgie (EEC) Paris France"},{"name":"Service de M\u00e9decine Physique et de R\u00e9adaptation CHRU Besan\u00e7on Besan\u00e7on Cedex France"},{"name":"Laboratoire d'anatomie UFR SMP Universit\u00e9 Bourgogne\/Franche\u2010Comt\u00e9 Besan\u00e7on Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,9,6]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(00)90072-8"},{"key":"e_1_2_10_3_1","unstructured":"AymardC(2009)ULIS\u202f: Des Donn\u00e9es Originales Pour Un Tour Du Monde Des Pratiques Actuelles. 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