Very educational video, thank you for sharing. Do you have any resources for starting doses for spasticity? For targeting the musculocutaneous nerve? This is an art that seems to be scarcely done unfortunately, at least in our area.
Here are a couple of articles: Combining botulinum toxin and phenol to manage spasticity in children Practice patterns for spasticity management with phenol neurolysis I use 5% or 6% phenol and combine with bupivicaine (1 ml bupivicaine to 2 ml phenol). I end up injecting about 1 to 3 mls into the musculocutaneous nerve. I agree, it is an art that is scarcely done. Botulinum toxin is easier to inject. But I feel these injections are way underused and of course much less expensive than botulinum toxin.
Good post. I had my 5th Botox treatment 3 weeks ago. I told the MD my quads are tight while the glutes, abductors, and hamstrings are not. Pain is in my quads. She injected something at the end that was not Botox but something she said would wear off in a few hours. I felt a nerve twitching when she put the needle in. She also told the clinician to add something to my next order for the pharmacy. I will call him Monday and ask. I find it difficult to ask the MD questions. I am an engineer and I like to know what is going on. Now I know about Phenol. Been using Dr. Ho's TENS since 2000. I am 155lbs and always exercising my whole life. This genetic condition pisses me off. I will go to North Dakota for Nerve Ablation and see if I am a good candidate. 3-1/2 year wait in Winnipeg. Our Canadian Heath Care system sucks. I will pay. I am wealthy. I can afford it. Will pay for a lower back MRI at Altru in North Dakota. I am booked here but 5 month wait.
@@UtahNeuroRehabilitation I am going to The Pain Medicine Center in Fargo, ND July 1, 2022 for Radiofrequency Ablation. 1st appointment. I am also going for a Lumbar MRI. I will have to go 3 times. I am not waiting over 3 years to get RFA in Winnipeg Canada. I will pay. I am going to the Health Science Centre tomorrow to see my Botox MD and she ordered Phenol as well. It only cost me $40. The Botox cost me $1300. Altru in Grand Forks was 10 times the cost of the Fargo clinic and imaging centre. I will drive the extra hour to save $11,000 USD
I have a question. I’m not sure if you can answer it but I hope so. My PT doctor and I were discussing doing Botox but he recently said he would like to try Phenol Alcohol injections. He said it last longer and it’s far less expensive. I have a tight right hip flexor and he said he’d like to try to straighten that out. My main concern is that I want my spasms and leg kicking to stop because it is extraordinary disruptive and makes it very hard to sleep at times. My question is…should the injections help with the kicking of my legs because if so, that would be amazing! The doctor also said if this doesn’t work we can talk about doing a surgery. hopefully you can answer my question. Have a wonderful day :)
I really like phenol in certain muscle (especially the hip adductors). It does seem to work better and last longer than Botox in this muscle group). I am not sure what muscles are leading to your kicking. Also, medications for spasticity might be helpful. There is another video on the Utah Neurorehabilitation UA-cam channel on this: It is on the Spasticity Play list.
@@UtahNeuroRehabilitation My doctor said they are going to inject into the nerves in my legs. Hopefully that’ll stop the kicking. I’m taking 60 mg of Baclofen a day but it doesn’t work as well as I would like. A lot of the muscles in my right leg are contributing to the kicking. The top of my leg, bottom of my leg, and my foot all spasm. Helping the spasticity in my right hip flexor would be nice but I’m more concerned with the very disruptive kicking spasm. I’m an athlete and the spasms are hindering my ability to be active. Hopefully this helps and if not like I’ve said my doctor said we can talk about a surgery to kill the nerves in my legs so they don’t kick anymore. He said the only concern would be loss of muscle tone but I’m a T10 paraplegic and realistically I’m never gonna walk again so muscle tone isn’t really an issue for me. Anyhow, thanks for replying :)
No worries, I’m not asking for medical advice just wondering since you seem pretty knowledgeable about this. I know that the Phenol injections help what tight muscles, but should it also help with the muscle kicking contractions also known as spasms? No hard feelings if you’re unable to answer.
We order through a local pharmacy 6% phenol. Make sure it is diluted to 5% to 7%. Once I was handed a vial that was not diluted. Fortunately, I recognized it and did not inject it.
My dad has had botox injections 3 times in his arm and leg one 200 mls and other two times 400mls for his spasitiy from a stroke but either one of those times did not work would phenol injection work
Without seeing him that is difficult to say. He may have a contracture. Check out the video "Is it Spasticity or Contracture". If it is a contracture, then the tendon/muscle is stuck in the shortened position and injections may not help. Also, it depends on how much Botox was put into each muscle. It is possible that phenol may be more effective.
Hi , how one can identify motor neurons and avoid sensory neuron while injecting phenol ? I see CP patients who are from very poor socioeconomic status and can't afford Butox I want to help them Ll be grateful if u can guide thanks
I agree that phenol is a great alternative that is much lower cost than the botulinum toxins. To avoid the sensory nerves, you can inject the motor points rather than the actual main nerve branch. However, you will likely get longer effect if you do inject the motor nerve. I find that the obturator nerve to the adductor muscles is relatively easy to find in the groin. Injecting this nerve is also typically highly effective for adductor spasticity. The sensory distribution is small. So I have not found pain to be a problem in this area. Injecting the hamstrings is trickier and more prone to sensory nerve issues. To avoid sensory nerves here, stimulate medial or lateral to the sciatic nerve into the hamstring motor nerve branches. Make sure that you do not have movement in the ankle plantarflexors that would indicate that you are in the main sciatic branch. The same technique can be used for the gastrocs.
@@UtahNeuroRehabilitation thanks a lot for your kind response can you guide what stimulator device is used to identify the nerve and is there any specific needle that you advise for use . Also what is your experience with phenol in Upper limb ?
I use a Dantec Clavis. It is pretty expensive, but it has both emg and stimulation modes. For phenol you only need the stimulation. I believe you can get simple nerve stimulators pretty inexpensively. You need the 1 stim per second rate. There are a bunch of emg injection needles available. We have been using one brand for a long time, but the quality has decreased and we will be switching: probably to neuroline. I have done much phenol into the upper extremities. The biceps brachii/brachialis most commonly. I inject the nerve proximally just under the pectoralis tendon. I watch to assure that there is no stimulation of median nerve innervated muscles. I have injected the brachioradialis, flexor carpi radialis and flexor carpi ulnaris muscles also. Where are you located?
I been dealing with this for almost a year. 1st answers I found to deal with my clonus. This condition is debilitating sometimes.
Check out the Utah Neuro Rehabilitation UA-cam channel spasticity play list. It may give you more suggestions.
Great information. Wish I could find someone near me that offered those options and actually knows how to use them.
just got it done at Cincinnati children's worked literally instantly as soon as i woke up from surgery
Very educational video, thank you for sharing. Do you have any resources for starting doses for spasticity? For targeting the musculocutaneous nerve? This is an art that seems to be scarcely done unfortunately, at least in our area.
Here are a couple of articles:
Combining botulinum toxin and phenol to manage spasticity in children
Practice patterns for spasticity management with phenol neurolysis
I use 5% or 6% phenol and combine with bupivicaine (1 ml bupivicaine to 2 ml phenol). I end up injecting about 1 to 3 mls into the musculocutaneous nerve. I agree, it is an art that is scarcely done. Botulinum toxin is easier to inject. But I feel these injections are way underused and of course much less expensive than botulinum toxin.
Good post. I had my 5th Botox treatment 3 weeks ago. I told the MD my quads are tight while the glutes, abductors, and hamstrings are not. Pain is in my quads. She injected something at the end that was not Botox but something she said would wear off in a few hours. I felt a nerve twitching when she put the needle in. She also told the clinician to add something to my next order for the pharmacy. I will call him Monday and ask. I find it difficult to ask the MD questions. I am an engineer and I like to know what is going on. Now I know about Phenol. Been using Dr. Ho's TENS since 2000. I am 155lbs and always exercising my whole life. This genetic condition pisses me off. I will go to North Dakota for Nerve Ablation and see if I am a good candidate. 3-1/2 year wait in Winnipeg. Our Canadian Heath Care system sucks. I will pay. I am wealthy. I can afford it. Will pay for a lower back MRI at Altru in North Dakota. I am booked here but 5 month wait.
Thanks for sharing. That is a ridiculous wait.
@@UtahNeuroRehabilitation I am going to The Pain Medicine Center in Fargo, ND July 1, 2022 for Radiofrequency Ablation. 1st appointment. I am also going for a Lumbar MRI. I will have to go 3 times. I am not waiting over 3 years to get RFA in Winnipeg Canada. I will pay. I am going to the Health Science Centre tomorrow to see my Botox MD and she ordered Phenol as well. It only cost me $40. The Botox cost me $1300. Altru in Grand Forks was 10 times the cost of the Fargo clinic and imaging centre. I will drive the extra hour to save $11,000 USD
Great we need more videos..PLS
I have a question. I’m not sure if you can answer it but I hope so. My PT doctor and I were discussing doing Botox but he recently said he would like to try Phenol Alcohol injections. He said it last longer and it’s far less expensive. I have a tight right hip flexor and he said he’d like to try to straighten that out. My main concern is that I want my spasms and leg kicking to stop because it is extraordinary disruptive and makes it very hard to sleep at times. My question is…should the injections help with the kicking of my legs because if so, that would be amazing! The doctor also said if this doesn’t work we can talk about doing a surgery. hopefully you can answer my question. Have a wonderful day :)
I really like phenol in certain muscle (especially the hip adductors). It does seem to work better and last longer than Botox in this muscle group). I am not sure what muscles are leading to your kicking. Also, medications for spasticity might be helpful. There is another video on the Utah Neurorehabilitation UA-cam channel on this: It is on the Spasticity Play list.
@@UtahNeuroRehabilitation My doctor said they are going to inject into the nerves in my legs. Hopefully that’ll stop the kicking. I’m taking 60 mg of Baclofen a day but it doesn’t work as well as I would like. A lot of the muscles in my right leg are contributing to the kicking. The top of my leg, bottom of my leg, and my foot all spasm. Helping the spasticity in my right hip flexor would be nice but I’m more concerned with the very disruptive kicking spasm. I’m an athlete and the spasms are hindering my ability to be active. Hopefully this helps and if not like I’ve said my doctor said we can talk about a surgery to kill the nerves in my legs so they don’t kick anymore. He said the only concern would be loss of muscle tone but I’m a T10 paraplegic and realistically I’m never gonna walk again so muscle tone isn’t really an issue for me. Anyhow, thanks for replying :)
No worries, I’m not asking for medical advice just wondering since you seem pretty knowledgeable about this. I know that the Phenol injections help what tight muscles, but should it also help with the muscle kicking contractions also known as spasms? No hard feelings if you’re unable to answer.
Can I do the velocity dependent test myself to know if I have spasticity? Or I need other person?
That's an interesting question. You could do it on yourself on some of your muscles. The ankle, elbow, wrist, fingers should work to do it yourself.
How to place order tell me
We order through a local pharmacy 6% phenol. Make sure it is diluted to 5% to 7%. Once I was handed a vial that was not diluted. Fortunately, I recognized it and did not inject it.
You could have a pharmacy call the outpatient pharmacy at the University of Utah to see exactly how they mix it.
My dad has had botox injections 3 times in his arm and leg one 200 mls and other two times 400mls for his spasitiy from a stroke but either one of those times did not work would phenol injection work
Without seeing him that is difficult to say. He may have a contracture. Check out the video "Is it Spasticity or Contracture". If it is a contracture, then the tendon/muscle is stuck in the shortened position and injections may not help. Also, it depends on how much Botox was put into each muscle. It is possible that phenol may be more effective.
Hi , how one can identify motor neurons and avoid sensory neuron while injecting phenol ?
I see CP patients who are from very poor socioeconomic status and can't afford Butox I want to help them
Ll be grateful if u can guide thanks
I agree that phenol is a great alternative that is much lower cost than the botulinum toxins. To avoid the sensory nerves, you can inject the motor points rather than the actual main nerve branch. However, you will likely get longer effect if you do inject the motor nerve. I find that the obturator nerve to the adductor muscles is relatively easy to find in the groin. Injecting this nerve is also typically highly effective for adductor spasticity. The sensory distribution is small. So I have not found pain to be a problem in this area. Injecting the hamstrings is trickier and more prone to sensory nerve issues. To avoid sensory nerves here, stimulate medial or lateral to the sciatic nerve into the hamstring motor nerve branches. Make sure that you do not have movement in the ankle plantarflexors that would indicate that you are in the main sciatic branch. The same technique can be used for the gastrocs.
@@UtahNeuroRehabilitation thanks a lot for your kind response can you guide what stimulator device is used to identify the nerve and is there any specific needle that you advise for use .
Also what is your experience with phenol in Upper limb ?
I use a Dantec Clavis. It is pretty expensive, but it has both emg and stimulation modes. For phenol you only need the stimulation. I believe you can get simple nerve stimulators pretty inexpensively. You need the 1 stim per second rate. There are a bunch of emg injection needles available. We have been using one brand for a long time, but the quality has decreased and we will be switching: probably to neuroline.
I have done much phenol into the upper extremities. The biceps brachii/brachialis most commonly. I inject the nerve proximally just under the pectoralis tendon. I watch to assure that there is no stimulation of median nerve innervated muscles. I have injected the brachioradialis, flexor carpi radialis and flexor carpi ulnaris muscles also. Where are you located?
@@UtahNeuroRehabilitation thank u so much
You are a very helpful person
God bless u