Intramuscular nerve distribution pattern in the pronator teres and flexor digitorum superficialis of children: provide anatomical positioning for the injection of BTX-A
XU Yan, YANG Fang-jiu, XIE Xia-dan, YANG Sheng-bo, LUO Huai-xiang, XIE Peng
Chinese Journal of Clinical Anatomy ›› 2017, Vol. 35 ›› Issue (5) : 481-484.
Intramuscular nerve distribution pattern in the pronator teres and flexor digitorum superficialis of children: provide anatomical positioning for the injection of BTX-A
Objective To examine the distribution pattern of intramuscular terminal neurons in the pronator teres and flexor digitorum superficialis muscles in children in order to provide the appropriate anatomical positioning for BTX-A injection in the treatment of forelimb myospasms in children with cerebral palsy. Methods The distribution pattern of intramuscular nerve branches within the pronator teres and flexor digitorum superficialis of children was observed by using the modified Sihler’s intramuscular nerve staining. Results Two nerve entry points (upper and lower) lead to the pronator teres. The lower nerve branch was wider and more extensively distributed. Its intramuscular branches were broom-like, and the adjacent nerve branch terminals had significant convergences of “O” and “Y” shapes. The intramuscular nerve terminal dense zones of this muscle lied in the middle of the muscle belly. The flexor digitorum superficialis had three nerve entry points, namely the upper, middle, and lower entry points. The intramuscular nerve terminal dense zones could be divided into the upper, middle, and lower parts, among which the middle part was the most concentrated. The “Y” and “O” convergences could be observed between the various terminal neurons. Conclusions The intramuscular nerve terminal dense zones of the pronator teres and flexor digitorum superficialis are both located in the middle part of the muscle belly. Thus, when children with cerebral palsy experience myospasms at these two muscles, the middle part of the muscle belly should be chosen as the best target area for BTX-A injection in the treatment of myospasms.
Cerebral palsy; / Pronation teres; / Flexor digitorum superficialis; / Intramuscular nerve; / BTX-A
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