Abstract
Injecting botulinum toxin type A (BTX-A) into spastic muscles is a recent alternative for treating conditions such as stroke, spinal cord injury, and cerebral palsy. BTX-A injection blocks acetylcholine release at the neuromuscular junction (NMJ) in the muscles. Therefore, BTX-A must be injected near the NMJ. In this paper, the anatomical, histochemical, and electrophysiological studies to determine the location of NMJs in the extremities are reviewed. Further, methylene blue vital staining as a method to identify the intramuscular nerve fibers and NMJs in the muscle and propose a so-called “mid portion of muscle fibers” along with the NMJ map of the upper and lower limbs are discussed.
