Botulinum toxin treatment for difficult-to-treat finger pressure ulcers caused by severe hand flexion: case report

We report the successful treatment of two cases of difficult-to-treat pressure ulcers with botulinum toxin type A (BoNT-A). A 71-year-old male patient with Parkinson's disease presented with severe hand grip deformities of the fingers and a pressure ulcer (PU) on the right hand. He received 240U of BoNT-A into the upper limb muscles, which improved finger mobility during passive extension and resulted in resolution of the palm PU. No recurrence was noted. A 69-year-old female patient with Lewy body dementia presented with a PU on the palm side of the middle finger apex of the right hand, with exposure of the phalanx bone and dark red oedematous granulation of the tip of the finger. Severe muscle tone was noted. She received 240U of BoNT-A injected into the muscles of the upper extremities. This resulted in the disappearance of the contracture between the middle finger cusp and palm, and prompt healing of the PU. A protective finger orthosis was also used to improve hand finger grip and prevent further PUs. Although BoNT-A injection resulted in only slight improvement in the range of motion, it produced relief of pressure with consequent healing of the PU. Injection of BoNT-A into the affected muscles of the patients in this case report was effective in reducing flexor muscle tone, relief of pressure on the palm skin and healing of hand PUs.

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Constraint-Induced Movement Therapy After Injection of Botulinum Toxin Type A for a Patient With Chronic Stroke: One-Year Follow-up Case Report

Physical Therapy ◽

10.2522/ptj.20140329 ◽

2015 ◽

Vol 95 (7) ◽

pp. 1039-1045 ◽

Cited By ~ 4

Author(s):

Satoru Amano ◽

Takashi Takebayashi ◽

Keisuke Hanada ◽

Atsushi Umeji ◽

Kohei Marumoto ◽

...

Keyword(s):

Case Report ◽

Botulinum Toxin ◽

Muscle Tone ◽

Botulinum Toxin Type A ◽

Type A ◽

Movement Therapy ◽

Chronic Stroke ◽

Constraint Induced Movement Therapy ◽

Arm Function

Background and Purpose Spasticity, an aspect of upper motor neuron syndrome, is a widespread problem in patients with stroke. To date, no study has reported the long-term (up to 1 year) outcomes of botulinum toxin (BTX) injection in combination with constraint-induced movement therapy in patients with chronic stroke. In this case report, the long-term (1 year) effects of the combination of BTX type A injection and constraint-induced movement therapy on spasticity and arm function in a patient with chronic stroke and arm paresis are described. Case Description The patient was a 66-year-old man who had had an infarction in the right posterior limb of the internal capsule 4 years before the intervention. At screening, the patient was not able to voluntarily extend his interphalangeal or metacarpophalangeal joints beyond the 10 degrees required for constraint-induced movement therapy. From 12 days after BTX type A injection, the patient received 5 hours of constraint-induced movement therapy for 10 weekdays. Outcomes All outcome measures (Modified Ashworth Scale, Fugl-Meyer Assessment, Action Research Arm Test, and amount of use scale of the Motor Activity Log) improved substantially over the 1-year period (before intervention to 1 year after intervention). Repeat BTX type A injections were not necessary because muscle tone and arm function did not worsen during the observation period. Discussion The improved arm function may have reflected improvements in volitional movements and coordination or speed of movements in the paretic arm as a result of a reduction in spasticity, a reduction of learned nonuse behaviors, or use-dependent plasticity after the combination of BTX type A injection and constraint-induced movement therapy. In addition, the possibility of an influence of the passage of time or the Hawthorne effect cannot be ruled out. If this approach proves useful in future controlled studies, it may reduce the rising medical costs of the treatment of stroke.

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Typical Evolution of a Cutaneous Anthrax Lesion

Infectious Diseases and Clinical Microbiology ◽

10.36519/idcm.2020.0007 ◽

2020 ◽

Vol 2 (1) ◽

pp. 27-29

Author(s):

Cansu Cansu Çimen

Keyword(s):

Case Report ◽

Clinical Practice ◽

Infectious Diseases ◽

Female Patient ◽

Outpatient Clinic ◽

Middle Finger ◽

Disease Course ◽

Right Hand ◽

Cutaneous Anthrax ◽

The Right

An illustrated case of cutaneous anthrax acquired in eastern Turkey was described in this report. A 56-year-old female patient applied to the infectious diseases outpatient clinic with a painless, dark-colored swelling over her right middle finger accompanied by edema extending to the right hand. Typical disease course of a cutaneous anthrax lesion evolved in a few days. This case report was presented in order to help clinicians to recognize the different stages of the disease in clinical practice. Keywords: anthrax , cutaneous anthrax , eschar , edema

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Rheumatoid Arthritis Induced by Botulinum Toxin Type A: A Case Report and Review of the Literature

Austin Journal of Orthopedics & Rheumatology ◽

10.26420/austinjorthopaderheumatol.2021.1096 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Yanyan G ◽

◽

Yupeng L ◽

Yuanyuan L ◽

Fangfang Z ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Botulinum Toxin ◽

Side Effects ◽

Clinical Application ◽

Botulinum Toxin Type A ◽

Type A ◽

Botulinum Toxin Type ◽

Interphalangeal Joint ◽

Right Hand ◽

The Right

Introduction: Botulinum Toxin Type A (BoNT/A) is a bacterial toxin commonly used in cosmetic therapy. Although there has been a great deal of clinical and basic research on the potential therapeutic applications of botulinum toxin there are few reports on its clinical toxicity and side effects. Patient Concerns: A previously healthy 26-year-old woman developed joint pain and redness in her right toe, swelling in the posterior left foot and the interphalangeal joint of the right index finger, occasional shoulder pain, and morning stiffness for 30 minutes daily, 6 months after BoNT/A injection. Diagnosis: Laboratory testing showed elevated Rheumatoid Factor (RF), anti-cyclic citrullinated peptide (anti-CCP), C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR). Doppler ultrasound examination of the right hand and both feet showed synovial hyperplasia of the right wrist, right second proximal interphalangeal joint, both ankles, and right first metatarsophalangeal joint, as well as bony erosion in a left intertarsal joint. Magnetic Resonance (MR) examination for right hand showed multiple joint changes of right hand and wrist, which included synovium thickening and enhancement. She was diagnosed as rheumatoid arthritis. Interventions: BoNT/A injection was stopped. Methotrexate 10mg was given once weekly and hydroxychloroquine 0.2g was given twice daily with subsequent remission of arthritis. Outcomes: At 12 months from diagnosis, patient reported complete joints remission. Conclusions: This is the first report of rheumatoid arthritis caused by botulinum toxin injection, and we speculate on the mechanism of its occurrence in this paper. In addition, we systematically introduce the latest research results on the development mechanism of BoNT/A causing RA. This review suggests that it is necessary to further explore the specific mechanism of RA or osteochondral injury caused by BoNT/A, which will not only help to improve the current understanding of the potential toxic and side effects of BoNT/A in clinical application, but also promote the standardization of clinical application of BoNT/A.

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Bilateral Opponens Replacement in Post Polio Thenar Paralysis, Using Different Techniques. A Case Report.

HAND ◽

10.1016/s0072-968x(83)80019-9 ◽

1983 ◽

Vol os-15 (2) ◽

pp. 221-222 ◽

Cited By ~ 1

Author(s):

J. G. Andersen ◽

J. W. Brandsma

Keyword(s):

Case Report ◽

Ring Finger ◽

Flexor Digitorum Superficialis ◽

Left Hand ◽

Right Hand ◽

Abductor Digiti Minimi ◽

The Right ◽

Flexor Digitorum

A patient is presented with bilateral thenar paralysis, due to poliomyelitis. On the right hand a successful abductor digiti minimi transfer was performed. On the left hand weakness of the hypothenar muscles prevented a good result. Subsequently an opponens replacement, using flexor digitorum superficialis from the ring finger, yielded a good result.

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CP-107 Use of botulinum toxin type A in esophageal achalasia: a case report

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2013-000436.105 ◽

2014 ◽

Vol 21 (Suppl 1) ◽

pp. A43.1-A43

Author(s):

M Montserrat ◽

A Rizo ◽

A Lloret ◽

C Bayarri

Keyword(s):

Case Report ◽

Botulinum Toxin ◽

Botulinum Toxin Type A ◽

Type A ◽

Esophageal Achalasia ◽

Botulinum Toxin Type

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Botulinum toxin type A for the treatment of muscle contractures secondary to acute spinal cord injury in a young cat

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116920922648 ◽

2020 ◽

Vol 6 (1) ◽

pp. 205511692092264

Author(s):

Robert I McGeachan ◽

Tobias Schwarz ◽

Danièlle A Gunn-Moore ◽

Katia Marioni-Henry

Keyword(s):

Spinal Cord ◽

Botulinum Toxin ◽

Botulinum Toxin Type A ◽

Clinical Signs ◽

Type A ◽

Botulinum Toxin Type ◽

Subacute Stroke ◽

Thoracic Limb ◽

Cord Injury ◽

The Right

Case summary A 4-month-old male entire domestic shorthair cat presented for sudden onset of right thoracic monoparesis following a fall; within 18 h, the clinical signs progressed to non-ambulatory right hemiplegia with absent sensation in the distal right thoracic limb and left hemiparesis. MRI revealed changes consistent with a C6–C7 acute non-compressive nucleus pulposus extrusion with suspected secondary C5–C7 spinal cord haemorrhage. Rehabilitation exercises were started immediately after the diagnosis of acute spinal cord trauma. Sensation in the right thoracic limb improved and, with the help of a splint applied to that limb, the cat was ambulatory on all four limbs. Unfortunately, clinical signs started to progress over the course of 10 days. The cat developed progressive discomfort on manipulation of the right elbow and carpus, and a hyperflexion of the right carpus. Radiographs revealed no skeletal abnormalities. Muscle contractures were suspected. Under general anaesthesia the triceps and flexor muscles of the carpus and digits were injected with a total of 100 U of botulinum toxin type A (BTX-A). No complications were associated with the procedure and 24 h after the injection the carpal hyperflexion resolved. Relevance and novel information The use of BTX-A to treat muscle contractures in human medicine is an established and increasingly used technique. For example, in subacute stroke patients with a non-functional arm, BTX-A forearm injection appears to prevent disabling finger stiffness, likely by minimising the development of contractures. Here, we demonstrate that intramuscular BTX-A is an effective treatment for acquired muscle contractures in a cat.

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