Subscribe to RSS
DOI: 10.1055/s-0036-1594284
Botulinum Toxin Injections in Musculoskeletal Disorders
Publication History
Publication Date:
21 December 2016 (online)
![](https://www.thieme-connect.de/media/smr/201605/lookinside/thumbnails/10-1055-s-0036-1594284_00918-1.jpg)
Abstract
Botulinum toxin (BTX) is used for multiple clinical indications due to its ability to induce temporary chemodenervation and muscle paralysis. This property has supported its application in treating a variety of musculoskeletal conditions, especially those involving muscular hyperactivity and contractures such as cerebral palsy and dystonia. However, off-label use of BTX injection in other musculoskeletal disorders is gaining increased acceptance, such as in neurogenic thoracic outlet syndrome, epicondylitis, and shoulder pain after stroke. This review discusses the mechanism of action, best practices, and current indications of BTX injections in the musculoskeletal system. We also discuss the state of the science regarding BTX injections for musculoskeletal disorders and the available evidence supporting its use.
-
References
- 1 Arnon SS, Schechter R, Inglesby TV , et al; Working Group on Civilian Biodefense. Botulinum toxin as a biological weapon: medical and public health management. JAMA 2001; 285 (8) 1059-1070
- 2 Wheeler A, Smith HS. Botulinum toxins: mechanisms of action, antinociception and clinical applications. Toxicology 2013; 306: 124-146
- 3 Ishikawa H, Mitsui Y, Yoshitomi T , et al. Presynaptic effects of botulinum toxin type A on the neuronally evoked response of albino and pigmented rabbit iris sphincter and dilator muscles. Jpn J Ophthalmol 2000; 44 (2) 106-109
- 4 Seyler TM, Smith BP, Marker DR , et al. Botulinum neurotoxin as a therapeutic modality in orthopaedic surgery: more than twenty years of experience. J Bone Joint Surg Am 2008; 90 (Suppl. 04) 133-145
- 5 Hofmann RJ. Treatment of Frey's syndrome (gustatory sweating) and ‘crocodile tears’ (gustatory epiphora) with purified botulinum toxin. Ophthal Plast Reconstr Surg 2000; 16 (4) 289-291
- 6 Cordivari C, Misra VP, Catania S, Lees AJ. New therapeutic indications for botulinum toxins. Mov Disord 2004; 19 (Suppl. 08) S157-S161
- 7 Schnider P, Binder M, Kittler H , et al. A randomized, double-blind, placebo-controlled trial of botulinum A toxin for severe axillary hyperhidrosis. Br J Dermatol 1999; 140 (4) 677-680
- 8 Laing TA, Laing ME, O'Sullivan ST. Botulinum toxin for treatment of glandular hypersecretory disorders. J Plast Reconstr Aesthet Surg 2008; 61 (9) 1024-1028
- 9 Setler PE. Therapeutic use of botulinum toxins: background and history. Clin J Pain 2002; 18 (6, Suppl) S119-S124
- 10 Brin MF, Blitzer A, Stewart C , et al. Disorders with excessive muscle contraction: candidates for treatment with intramuscular botulinum toxin (“botox”). In: DasGupta BR, , ed. Botulinum and Tetanus Neurotoxins. New York, NY: Springer; 1993: 559-576
- 11 Kaji R, Osako Y, Suyama K, Maeda T, Uechi Y, Iwasaki M ; GSK1358820 Spasticity Study Group. Botulinum toxin type A in post-stroke lower limb spasticity: a multicenter, double-blind, placebo-controlled trial. J Neurol 2010; 257 (8) 1330-1337
- 12 Rosales RL, Chua-Yap AS. Evidence-based systematic review on the efficacy and safety of botulinum toxin-A therapy in post-stroke spasticity. J Neural Transm (Vienna) 2008; 115 (4) 617-623
- 13 Filippi GM, Errico P, Santarelli R, Bagolini B, Manni E. Botulinum A toxin effects on rat jaw muscle spindles. Acta Otolaryngol 1993; 113 (3) 400-404
- 14 Hatheway CL, Dang C. Immunogenicity of the neurotoxins of Clostridium botulinum. In Jankovic J, Hallett M, , eds. Therapy with Botulinum Toxin. New York, NY: Marcel Dekker; 1994: 93-107
- 15 Pearce LB, Borodic GE, Johnson EA, First ER, MacCallum R. The median paralysis unit: a more pharmacologically relevant unit of biologic activity for botulinum toxin. Toxicon 1995; 33 (2) 217-227
- 16 Polak RL, Sellin LC, Thesleff S. Acetylcholine content and release in denervated or botulinum poisoned rat skeletal muscle. J Physiol 1981; 319 (1) 253-259
- 17 Mclellan K, Das REG, Ekong TAN, Sesardic D. Therapeutic botulinum type A toxin: factors affecting potency. Toxicon 1996; 34 (9) 975-985
- 18 Blitzer A. Botulinum toxin A and B: a comparative dosing study for spasmodic dysphonia. Otolaryngol Head Neck Surg 2005; 133 (6) 836-838
- 19 BOTOX R. Cosmetic (Botulinum Toxin Type A) Purified Neurotoxin Complex [package insert]. Dublin, Ireland: Allergan Inc; 2002
- 20 Huang W, Foster JA, Rogachefsky AS. Pharmacology of botulinum toxin. J Am Acad Dermatol 2000; 43 (2 Pt 1): 249-259
- 21 Parish JL. Commercial preparations and handling of botulinum toxin type A and type B. Clin Dermatol 2003; 21 (6) 481-484
- 22 Callaway JE, Arezzo JC, Grethlein AJ. Botulinum toxin type B: an overview of its biochemistry and preclinical pharmacology. Dis Mon 2002; 48 (5) 367-383
- 23 Redaelli A, Forte R. Botulinum toxin dilution: our technique. J Cosmet Laser Ther 2003; 5 (03/04) 218-219
- 24 Benedetto AV. The cosmetic uses of Botulinum toxin type A. Int J Dermatol 1999; 38 (9) 641-655
- 25 Flynn TC, Carruthers A, Carruthers J. Surgical pearl: the use of the Ultra-Fine II short needle 0.3-cc insulin syringe for botulinum toxin injections. J Am Acad Dermatol 2002; 46 (6) 931-933
- 26 Scott AB. Development of botulinum toxin therapy. Dermatol Clin 2004; 22 (2) 131-133 , v
- 27 Klein AW. Dilution and storage of botulinum toxin. Dermatol Surg 1998; 24 (11) 1179-1180
- 28 Baumann L, Black L. Botulinum toxin type B (Myobloc). Dermatol Surg 2003; 29 (5) 496-500 ; discussion 500
- 29 Comella CL, Jankovic J, Shannon KM , et al; Dystonia Study Group. Comparison of botulinum toxin serotypes A and B for the treatment of cervical dystonia. Neurology 2005; 65 (9) 1423-1429
- 30 Gartlan MG, Hoffman HT. Crystalline preparation of botulinum toxin type A (Botox): degradation in potency with storage. Otolaryngol Head Neck Surg 1993; 108 (2) 135-140
- 31 Sloop RR, Cole BA, Escutin RO. Reconstituted botulinum toxin type A does not lose potency in humans if it is refrozen or refrigerated for 2 weeks before use. Neurology 1997; 48 (1) 249-253
- 32 Garcia A, Fulton Jr JE. Cosmetic denervation of the muscles of facial expression with botulinum toxin. A dose-response study. Dermatol Surg 1996; 22 (1) 39-43
- 33 Alam M, Dover JS, Arndt KA. Pain associated with injection of botulinum A exotoxin reconstituted using isotonic sodium chloride with and without preservative: a double-blind, randomized controlled trial. Arch Dermatol 2002; 138 (4) 510-514
- 34 Koman LA, Mooney III JF, Smith B, Goodman A, Mulvaney T. Management of cerebral palsy with botulinum-A toxin: preliminary investigation. J Pediatr Orthop 1993; 13 (4) 489-495
- 35 Koman LA, Mooney III JF, Smith BP, Goodman A, Mulvaney T. Management of spasticity in cerebral palsy with botulinum-A toxin: report of a preliminary, randomized, double-blind trial. J Pediatr Orthop 1994; 14 (3) 299-303
- 36 Van Heest AE. Applications of botulinum toxin in orthopedics and upper extremity surgery. Tech Hand Up Extrem Surg 1997; 1 (1) 27-34
- 37 Willenborg MJ, Shilt JS, Smith BP, Estrada RL, Castle JA, Koman LA. Technique for iliopsoas ultrasound-guided active electromyography-directed botulinum A toxin injection in cerebral palsy. J Pediatr Orthop 2002; 22 (2) 165-168
- 38 Torriani M, Gupta R, Donahue DM. Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using an ultrasound-guided approach. Skeletal Radiol 2010; 39 (10) 973-980
- 39 Sarifakioglu N, Sarifakioglu E. Evaluating the effects of ice application on the pain felt during botulinum toxin type-A injections: a prospective, randomized, single-blind controlled trial. Ann Plast Surg 2004; 53 (6) 543-546
- 40 Eames NW, Baker R, Hill N, Graham K, Taylor T, Cosgrove A. The effect of botulinum toxin A on gastrocnemius length: magnitude and duration of response. Dev Med Child Neurol 1999; 41 (4) 226-232
- 41 Herrero BA, Ecklung AE, Streett CS, Ford DF, King JK. Experimental botulism in monkeys—a clinical pathological study. Exp Mol Pathol 1967; 6 (1) 84-95
- 42 Scott AB, Suzuki D. Systemic toxicity of botulinum toxin by intramuscular injection in the monkey. Mov Disord 1988; 3 (4) 333-335
- 43 U.S. Food and Drug Administration. Early communication about an ongoing safety review Botox and Botox Cosmetic (botulinum toxin type A) and Myobloc (botulinum toxin type B). Plast Surg Nurs 2008; 28 (3) 150-151
- 44 Al-Al-Shaikh M, Michel F, Parratte B, Kastler B, Vidal C, Aubry S. An MRI evaluation of changes in piriformis muscle morphology induced by botulinum toxin injections in the treatment of piriformis syndrome. Diagn Interv Imaging 2015; 96 (1) 37-43
- 45 Schroeder AS, Ertl-Wagner B, Britsch S , et al. Muscle biopsy substantiates long-term MRI alterations one year after a single dose of botulinum toxin injected into the lateral gastrocnemius muscle of healthy volunteers. Mov Disord 2009; 24 (10) 1494-1503
- 46 Brin MF, Fahn S, Moskowitz C , et al. Localized injections of botulinum toxin for the treatment of focal dystonia and hemifacial spasm. Mov Disord 1987; 2 (4) 237-254
- 47 Greene P, Fahn S, Diamond B. Development of resistance to botulinum toxin type A in patients with torticollis. Mov Disord 1994; 9 (2) 213-217
- 48 Hanna PA, Jankovic J, Vincent A. Comparison of mouse bioassay and immunoprecipitation assay for botulinum toxin antibodies. J Neurol Neurosurg Psychiatry 1999; 66 (5) 612-616
- 49 Jankovic J, Ahsan J, Vuong KD. Comparison of immunogenicity of old versus current BOTOX in cervical dystonia. In: Roland Seifert, ed. Naunyn-Schmiedeberg's Archives of Pharmacology. Vol 365. New York, NY: Springer; 2002: R25-R25
- 50 Brin MF, Lew MF, Adler CH , et al. Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-resistant cervical dystonia. Neurology 1999; 53 (7) 1431-1438
- 51 Factor SA, Molho ES, Evans S, Feustel PJ. Efficacy and safety of repeated doses of botulinum toxin type B in type A resistant and responsive cervical dystonia. Mov Disord 2005; 20 (9) 1152-1160
- 52 Jankovic J, Tsui J, Bergeron C. Prevalence of cervical dystonia and spasmodic torticollis in the United States general population. Parkinsonism Relat Disord 2007; 13 (7) 411-416
- 53 Ranoux D, Gury C, Fondarai J, Mas JL, Zuber M. Respective potencies of Botox and Dysport: a double blind, randomised, crossover study in cervical dystonia. J Neurol Neurosurg Psychiatry 2002; 72 (4) 459-462
- 54 Marchetti A, Magar R, Findley L , et al. Retrospective evaluation of the dose of Dysport and BOTOX in the management of cervical dystonia and blepharospasm: the REAL DOSE study. Mov Disord 2005; 20 (8) 937-944
- 55 Truong DD, Cullis PA, O'Brien CF, Koller M, Villegas TP, Wallace JD. BotB (botulinum toxin type B): evaluation of safety and tolerability in botulinum toxin type A-resistant cervical dystonia patients (preliminary study). Mov Disord 1997; 12 (5) 772-775
- 56 Cans C ; Surveillance of Cerebral Palsy in Europe. Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Surveillance of Cerebral Palsy in Europe (SCPE). Dev Med Child Neurol 2000; 42 (12) 816-824
- 57 Reid SM, Carlin JB, Reddihough DS. Distribution of motor types in cerebral palsy: how do registry data compare?. Dev Med Child Neurol 2011; 53 (3) 233-238
- 58 Molenaers G, Van Campenhout A, Fagard K, De Cat J, Desloovere K. The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb. J Child Orthop 2010; 4 (3) 183-195
- 59 Lee JH, Sung IY, Yoo JY, Park EH, Park SR. Effects of different dilutions of botulinum toxin type A treatment for children with cerebral palsy with spastic ankle plantarflexor: a randomized controlled trial. J Rehabil Med 2009; 41 (9) 740-745
- 60 Lukban MB, Rosales RL, Dressler D. Effectiveness of botulinum toxin A for upper and lower limb spasticity in children with cerebral palsy: a summary of evidence. J Neural Transm (Vienna) 2009; 116 (3) 319-331
- 61 Bjornson K, Hays R, Graubert C , et al. Botulinum toxin for spasticity in children with cerebral palsy: a comprehensive evaluation. Pediatrics 2007; 120 (1) 49-58
- 62 Desloovere K, Molenaers G, De Cat J , et al. Motor function following multilevel botulinum toxin type A treatment in children with cerebral palsy. Dev Med Child Neurol 2007; 49 (1) 56-61
- 63 Scholtes VA, Dallmeijer AJ, Knol DL , et al. Effect of multilevel botulinum toxin a and comprehensive rehabilitation on gait in cerebral palsy. Pediatr Neurol 2007; 36 (1) 30-39
- 64 Sätilä H, Iisalo T, Pietikäinen T , et al. Botulinum toxin treatment of spastic equinus in cerebral palsy: a randomized trial comparing two injection sites. Am J Phys Med Rehabil 2005; 84 (5) 355-365 ; quiz 366–367, 392
- 65 Molenaers G, Fagard K, Van Campenhout A, Desloovere K. Botulinum toxin A treatment of the lower extremities in children with cerebral palsy. J Child Orthop 2013; 7 (5) 383-387
- 66 Demondion X, Herbinet P, Van Sint Jan S, Boutry N, Chantelot C, Cotten A. Imaging assessment of thoracic outlet syndrome. Radiographics 2006; 26 (6) 1735-1750
- 67 Christo PJ, McGreevy K. Updated perspectives on neurogenic thoracic outlet syndrome. Curr Pain Headache Rep 2011; 15 (1) 14-21
- 68 Jordan SE, Ahn SS, Gelabert HA. Combining ultrasonography and electromyography for botulinum chemodenervation treatment of thoracic outlet syndrome: comparison with fluoroscopy and electromyography guidance. Pain Physician 2007; 10 (4) 541-546
- 69 Jordan SE, Ahn SS, Freischlag JA, Gelabert HA, Machleder HI. Selective botulinum chemodenervation of the scalene muscles for treatment of neurogenic thoracic outlet syndrome. Ann Vasc Surg 2000; 14 (4) 365-369
- 70 Jordan SE, Ahn SS, Gelabert HA. Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation. Pain Physician 2007; 10 (3) 441-452
- 71 Lum YW, Brooke BS, Likes K , et al. Impact of anterior scalene lidocaine blocks on predicting surgical success in older patients with neurogenic thoracic outlet syndrome. J Vasc Surg 2012; 55 (5) 1370-1375
- 72 Torriani M, Gupta R, Donahue DM. Sonographically guided anesthetic injection of anterior scalene muscle for investigation of neurogenic thoracic outlet syndrome. Skeletal Radiol 2009; 38 (11) 1083-1087
- 73 Binder AI, Hazleman BL. Lateral humeral epicondylitis—a study of natural history and the effect of conservative therapy. Br J Rheumatol 1983; 22 (2) 73-76
- 74 Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol 2006; 164 (11) 1065-1074
- 75 Placzek R, Drescher W, Deuretzbacher G, Hempfing A, Meiss AL. Treatment of chronic radial epicondylitis with botulinum toxin A. A double-blind, placebo-controlled, randomized multicenter study. J Bone Joint Surg Am 2007; 89 (2) 255-260
- 76 De Smedt T, de Jong A, Van Leemput W, Lieven D, Van Glabbeek F. Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. Br J Sports Med 2007; 41 (11) 816-819
- 77 Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med 2011; 39 (6) 1200-1208
- 78 Wong SM, Hui ACF, Tong P-Y, Poon DWF, Yu E, Wong LKS. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2005; 143 (11) 793-797
- 79 Keizer SB, Rutten HP, Pilot P, Morré HHE, , v Os JJ, Verburg AD. Botulinum toxin injection versus surgical treatment for tennis elbow: a randomized pilot study. Clin Orthop Relat Res 2002; (401) 125-131
- 80 Ma J, Shen J, Smith BP, Ritting A, Smith TL, Koman LA. Bioprotection of tendon repair: adjunctive use of botulinum toxin A in Achilles tendon repair in the rat. J Bone Joint Surg Am 2007; 89 (10) 2241-2249
- 81 Tüzüner S, Balci N, Özkaynak S, Tuzuner S, Balci NN. Results of zone II flexor tendon repair in children younger than age 6 years: botulinum toxin type A administration eased cooperation during the rehabilitation and improved outcome. J Pediatr Orthop 2004; 24 (6) 629-633
- 82 Seyler TM, Jinnah RH, Koman LA , et al. Botulinum toxin type A injections for the management of flexion contractures following total knee arthroplasty. J Surg Orthop Adv 2008; 17 (4) 231-238
- 83 Bhave A, Zywiel MG, Ulrich SD , et al. Botulinum toxin type A injections for the management of muscle tightness following total hip arthroplasty: a case series. J Orthop Surg 2009; 4: 34
- 84 Shah SN, Hornyak J, Urquhart AG. Flexion contracture after total knee arthroplasty in a patient with Parkinson's disease: successful treatment with botulinum toxin type A. J Arthroplasty 2005; 20 (8) 1078-1080
- 85 Fish DE, Chang WS. Treatment of iliopsoas tendinitis after a left total hip arthroplasty with botulinum toxin type A. Pain Physician 2007; 10 (4) 565-571
- 86 Bergenudd H, Lindgärde F, Nilsson B, Petersson CJ. Shoulder pain in middle age. A study of prevalence and relation to occupational work load and psychosocial factors. Clin Orthop Relat Res 1988; (231) 234-238
- 87 van der Windt DA, Koes BW, de Jong BA, Bouter LM. Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 1995; 54 (12) 959-964
- 88 Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006; 10 (4) 287-333
- 89 da Silva GG, Sirena SA. Profile of patients referred to physiotherapy by a Primary Health Care Service in 2012. Epidemiol Serv Saúde 2015; 24 (1) 123-133
- 90 Price CIM. Shoulder pain after stroke: a research challenge. Age Ageing 2002; 31 (Suppl. 03) 36-38
- 91 Chae J, Mascarenhas D, Yu DT , et al. Poststroke shoulder pain: its relationship to motor impairment, activity limitation, and quality of life. Arch Phys Med Rehabil 2007; 88 (3) 298-301
- 92 Buchbinder R, Green S, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Syst Rev 2003; 1 (1) CD004016
- 93 Singh JA, Fitzgerald PM. Botulinum toxin for shoulder pain: a Cochrane systematic review. J Rheumatol 2011; 38 (3) 409-418
- 94 Brashear A, Gordon MF, Elovic E , et al; Botox Post-Stroke Spasticity Study Group. Intramuscular injection of botulinum toxin for the treatment of wrist and finger spasticity after a stroke. N Engl J Med 2002; 347 (6) 395-400
- 95 Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am 2003; 85-A (5) 872-877
- 96 Placzek R, Hölscher A, Deuretzbacher G, Meiss L, Perka C. Treatment of chronic plantar fasciitis with botulinum toxin A—an open pilot study on 25 patients with a 14-week-follow-up [in German]. Z Orthop Ihre Grenzgeb 2006; 144 (4) 405-409
- 97 Young CC, Rutherford DS, Niedfeldt MW. Treatment of plantar fasciitis. Am Fam Physician 2001; 63 (3) 467-474 , 477–478
- 98 Díaz-Llopis IV, Rodríguez-Ruíz CM, Mulet-Perry S, Mondéjar-Gómez FJ, Climent-Barberá JM, Cholbi-Llobel F. Randomized controlled study of the efficacy of the injection of botulinum toxin type A versus corticosteroids in chronic plantar fasciitis: results at one and six months. Clin Rehabil 2012; 26 (7) 594-606
- 99 Babcock MS, Foster L, Pasquina P, Jabbari B. Treatment of pain attributed to plantar fasciitis with botulinum toxin a: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil 2005; 84 (9) 649-654
- 100 Huang Y-C, Wei S-H, Wang H-K, Lieu F-K. Ultrasonographic guided botulinum toxin type A treatment for plantar fasciitis: an outcome-based investigation for treating pain and gait changes. J Rehabil Med 2010; 42 (2) 136-140
- 101 Peterlein C-D, Funk JF, Hölscher A, Schuh A, Placzek R. Is botulinum toxin A effective for the treatment of plantar fasciitis?. Clin J Pain 2012; 28 (6) 527-533
- 102 Jabbari B. Botulinum toxin treatment of piriformis syndrome. In: Jabbari B, , ed. Botulinum Toxin Treatment of Pain Disorders. New York, NY: Springer; 2015: 99-108
- 103 Michel F, Decavel P, Toussirot E , et al. The piriformis muscle syndrome: an exploration of anatomical context, pathophysiological hypotheses and diagnostic criteria. Ann Phys Rehabil Med 2013; 56 (4) 300-311
- 104 Michel F, Decavel P, Toussirot E , et al. Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients. Ann Phys Rehabil Med 2013; 56 (5) 371-383
- 105 Fanucci E, Masala S, Sodani G , et al. CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process. Eur Radiol 2001; 11 (12) 2543-2548
- 106 Fishman LM, Anderson C, Rosner B. BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil 2002; 81 (12) 936-942
- 107 Lang AM. Botulinum toxin type B in piriformis syndrome. Am J Phys Med Rehabil 2004; 83 (3) 198-202
- 108 Jackson JL, Browning R. Impact of national low back pain guidelines on clinical practice. South Med J 2005; 98 (2) 139-143
- 109 Frymoyer JW. Predicting disability from low back pain. Clin Orthop Relat Res 1992; (279) 101-109
- 110 Foster L, Clapp L, Erickson M, Jabbari B. Botulinum toxin A and chronic low back pain: a randomized, double-blind study. Neurology 2001; 56 (10) 1290-1293
- 111 Waseem Z, Boulias C, Gordon A, Ismail F, Sheean G, Furlan AD. Botulinum toxin injections for low-back pain and sciatica. Cochrane Database Syst Rev 2011; (1) CD008257
- 112 Food and Drug Administration. Information for Healthcare Professionals: OnabotulinumtoxinA (marketed as Botox/Botox Cosmetic), AbobotulinumtoxinA (marketed as Dysport) and RimabotulinumtoxinB (marketed as Myobloc). Available at: http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/drugsafetyinformationforheathcareprofessionals/ucm174949.htm . Accessed June 24, 2016
- 113 Finlayson HC, O'Connor RJ, Brasher PM, Travlos A. Botulinum toxin injection for management of thoracic outlet syndrome: a double-blind, randomized, controlled trial. Pain 2011; 152 (9) 2023-2028
- 114 Singh JA, Mahowald ML, Noorbaloochi S. Intra-articular botulinum toxin A for refractory shoulder pain: a randomized, double-blinded, placebo-controlled trial. Transl Res 2009; 153 (5) 205-216
- 115 Michel F, Aubry S, Decavel P, Parratte B. Clinical, ultrasonographic and CT markers for botulinum toxin injections into the piriformis muscle. Ann Phys Rehab Med 2013; 56 (Suppl. 01) e123-e124