Perioperative Botulinum Toxin A in the Surgical Management of Seizure-Related Shoulder Instability: A Case Report

JBJS Case Connect. 2021 Nov 11;11(4). doi: 10.2106/JBJS.CC.20.00688.

Abstract

Case: A 20-year-old woman presented with recurrent bilateral shoulder instability concurrent with severe, treatment-refractory epilepsy. Imaging revealed glenoid bone loss of 25% to 28% and large Hill-Sachs defects bilaterally. Bone graft augmentation of the glenoid and infill of the Hill-Sachs defects was performed bilaterally. Perioperative neuromuscular paralysis of shoulder girdle muscles with botulinum toxin was performed to facilitate recovery. Both shoulders at 2.5 and 4 years, respectively, demonstrate excellent stability and radiographic union despite continued seizure activity.

Conclusion: Perioperative neuromuscular paralysis with botulinum toxin may provide early graft protection after the surgical treatment of glenohumeral instability because of seizures.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Botulinum Toxins, Type A* / therapeutic use
  • Female
  • Humans
  • Joint Instability* / drug therapy
  • Joint Instability* / etiology
  • Joint Instability* / surgery
  • Seizures / complications
  • Seizures / etiology
  • Shoulder
  • Shoulder Dislocation* / complications
  • Shoulder Dislocation* / surgery
  • Shoulder Joint* / diagnostic imaging
  • Shoulder Joint* / surgery
  • Young Adult

Substances

  • Botulinum Toxins, Type A