Shriners Hospital Study Likely to Change Practice Regarding Use of Botulinum Toxin

Michelle James, M.D., Chief of Orthopaedics at the Shriners Hospital in Sacramento

May 6, 2015

SACRAMENTO, Calif. – Shriners Hospitals for Children – Northern California (SHCNC) was the lead site in a multi-center study that may advance the treatment of upper-extremity cerebral palsy that afflicts millions of children worldwide.

The study co-authored by Shriners Hospital physicians, “Tendon Transfer Surgery in Upper-Extremity Cerebral Palsy is More Effective than Botulinum Toxic Injections or Regular, Ongoing Therapy,” is the lead scientific article in the April issue of The Journal of Bone and Joint Surgery.

The study is likely to change medical practice regarding the use of botulinum toxin (one brand of which is called “botox”) in upper extremity cerebral palsy cases. Its conclusions portend greater emphasis on tendon transfer surgery in successfully mitigating upper-extremity muscle imbalances that cause elbow flexion, forearm pronation, wrist flexion, and clasped thumb in children with cerebral palsy.

Michelle James, M.D., a noted pediatric hand surgeon and Chief of Orthopaedics at the Northern California Shriners Hospital, was the senior author and a principal investigator for the study, which involved seven Shriners Hospitals across the country. Lead author was Ann Van Heest, M.D., from the University of Minnesota and Shriners Twin Cities Hospitals. Dr. Anita Bagley, co-director of the SHCNC Motion Analysis Lab co-authored the study, and SHCNC research coordinator Sherry Middleton also played a key role in making the study possible. The research team has published another article from the study, and has two additional articles in press.

“Thirty-nine children participated in the study, which was carefully designed by a working group of pediatric hand surgeons and therapists from seven different Shriners Hospitals. The study design took two years and subjects were recruited and studied for four additional years,” says Dr. James.

“For children who are surgical candidates, surgeons have often delayed surgery and treated them with botulinum toxin injections. We found that this delay was not justified by our results. For surgical candidates, tendon transfer surgery has better results one year post-operatively than botulinum toxin injections. This information will help children and their parents make decisions about the best treatment, once their child is a surgical candidate,” Dr. James adds.

The study was funded by Shriners Hospitals for Children.

Cerebral palsy is the most common cause of motor disability in children in North America and worldwide. SHCNC is home to one of the largest cerebral palsy programs in Northern California, where the hospital’s Cerebral Palsy Center of Excellence brings together a multidisciplinary team of experts into one center and to allow for complete care of the child.

Shriners Hospitals for Children is devoted to transforming the lives of children through excellence in treatment, teaching and research. Located at 2425 Stockton Boulevard in Sacramento, Shriners Hospitals for Children – Northern California provides care to children with orthopaedic conditions, spinal cord injuries, burns, cleft lip, scars from any cause and other complex surgical needs. There are no barriers to care as admission is based on age and diagnosis.   Care is provided regardless of the family’s ability to pay. For further information call (916) 453-2000 or go online to


Media Contact: Catherine Curran | Public Relations (916) 453-2218 |

Leave a Reply

Make an Appointment

Please call our Referral Center to schedule an appointment, call (916) 453-2191 or via email at A Referral Coordinator will partner with you to gather the necessary information to allow our physician leadership to evaluate the best path for your child.
a graphic of some silhouettes of children playing