PROCEDURE: Motor Point Blocks, Using Myobloc, Of

PATIENT: Smith, John MR#: 55556666 REFERRING PHYSICIAN: Jeffrey Englander, MD PHYSICIAN: Malcolm Lawton, MD; Jane Jones, MD DATE: 12/19/09

HISTORY: 50 y/o male with anoxic encephalopathy s/p near drowning accident 7/1/03 sent for Botox injections to right FCU and FDS.

PROCEDURE: Motor point blocks using botulinum toxin type A (Botox), of right wrist flexors and finger flexors.

INDICATION(S): To reduce unremitting tone in right wrist flexors and finger flexors.

PROCEDURE NOTE: After indications, alternatives, risks, and benefits of the procedure were explained to the patient, written informed consent was obtained. The patient was assisted with proper positioning. The skin in the vicinity of the injected muscles was prepared using alcohol swabs. Muscles were localized using anatomic landmarks and electrical stimulation using an injectable needle electrode. After the locations were confirmed to be nonvascular Botox was injected with a sterile 25 gauge needle. A total of 100 units were injected into the right upper extremity as follows:

Right flexor carpi ulnaris : 70 units Right flexor digitorum superficialis: 30 units

The patient tolerated the procedure well. He had no immediate adverse reaction or bleeding.

Botulinum Toxin Type A Lot # C2145 C3 exp 8/10

______Jane Jones, MD Resident Physician in PM&R

I attest that I was present during the above diagnostic test and that I have reviewed and approved this report.

______Malcolm Lawton, M.D. Attending Physician in PM&R