Table 1
TWSTRS, SCM deep fascia thickness, and SCM deep fascia stiffness before and after OnabotulinumtoxinA injection.
| PRE- INJECTION | POST- INJECTION | SITES OF INJECTION | |
|---|---|---|---|
| Average | |||
| TWSTRS | 52 ± 4 | 36 ± 8 | |
| Torticollis Severity | 21 ± 5 | 4 ± 3 | |
| Disability Scale | 17 ± 8 | 1 ± 4 | |
| Pain Scale | 16 ± 2 | 12 ± 5 | |
| SCM Deep Fascia Thickness | 1.7 ± 0.5 mm | 1.2 ± 0.2 mm | |
| Stiffness Deep Fascia to SCM Ratio | 1.10 ± 0.38 | 1.33 ± 0.48 | |
| Case 1 | R semispinalis capitus 10 units × 2 | ||
| TWSTRS | 56.25 | 36.25 | Fascial Plane Horizontal Intrarotation/Extrarotation: |
| Torticollis Severity | 21 | 7 | L SCM near mastoid process 10 units |
| Disability Scale | 17 | 11 | L SCM near clavicle 10 units |
| Pain Scale | 18.25 | 18.25 | L Splenius Capitus near Transverse process of C2–4 10 units × 2 |
| SCM Deep Fascia Thickness | 1.4 mm | 1.1 mm | R Levator scapula 10 units × 2 |
| Stiffness Deep Fascia to SCM Ratio | 0.86 | 0.97 | R Rhomboid minor at medial spine of scapula 10 units × 2 |
| Case 2 | R semispinalis capitus 10 units × 2 | ||
| TWSTRS | 49 | 15 | Fascial Plane Diagonal Spiral Antemedial/retrolateral: |
| Torticollis Severity | 26 | 3 | R/L alar nasalis 4 units × 2 |
| Disability Scale | 18 | 3 | L pectoralis minor at rib 2–4 4 units |
| Pain Scale | 15 | 9 | L SCM near sternoclavicular joint 10 units |
| SCM Deep Fascia Thickness | 1.7 mm | 1.4 mm | R Splenius capitus near C2–3 10 units × 2 |
| Stiffness Deep Fascia to SCM Ratio | 1.33 | 1.46 | R upper trapezius border 10 units × 2 |
| Case 3 | R semispinalis capitus 10 units × 2 | ||
| TWSTRS | 50 | 20.5 | Fascial Plane Horizontal Intrarotation/Extrarotation: |
| Torticollis Severity | 17 | 2 | L Auricularis anterior 4 units |
| Disability Scale | 17 | 9 | L SCM near mastoid process 10 units |
| Pain Scale | 16 | 9.5 | L SCM near clavicle 10 units |
| SCM Deep Fascia Thickness | 1.9 mm | 1.2 mm | L Splenius Capitus near Transverse process of C2–4 10 units × 2 |
| Stiffness Deep Fascia to SCM Ratio | 1.12 | 1.56 | L Levator scapula 10 units L Rhomboid minor at medial spine of scapula 10 units × 2 |
Figure 1
The right sternocleidomastoid was selected for injection under standard cervical dystonia assessment. This corresponded with the right CF (blue dot) located at the insertion site of the sternocleidomastoid at the sternoclavicular joint- allowing for more specificity in injection site selection.
Figure 2
Changes in deep fascia thickness before ONABOTULINUMTOXINA injection (A) and after ONABOTULINUMTOXINA injection (B) showing decrease in thickness.