Botox and Quadriceps

[pmr4life]

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Hey All,

Any suggestions/advice on using Botox in the knee extensors with spastic hemiparetic patients? How do you get the extensor tone to calm down without making the knee extensors too weak? Last thing I would want to do is take a patient who can somewhat comfortably ambulate with his/her tone and transition them to a gait where their knee collapses on heel strike or forces them to go into genu recurvatum every time they take a step.

Thanks for all advice!

 

[RUOkie]

Hey All,

Any suggestions/advice on using Botox in the knee extensors with spastic hemiparetic patients? How do you get the extensor tone to calm down without making the knee extensors too weak? Last thing I would want to do is take a patient who can somewhat comfortably ambulate with his/her tone and transition them to a gait where their knee collapses on heel strike or forces them to go into genu recurvatum every time they take a step.

Thanks for all advice!

start low and go slow. I usually start with the distal muscles and put 75 units in the quads on the first injection. THen adjust as needed for subsequent injections.