Clinical applications of Botox in a Hand Surgery Practice
Spasticity refers to muscles that go into permanent
spasm with resultant deformity, disability and even pain. The surgical
application for spasticity has been used for many years in children who suffer
from birth-related ischaemic events (like Cerebral Palsy) but also in adults
who have suffered from a stroke. This typically presents with spasticity on one
or sides called hemiplegia and might be expressed in different severities in
the upper and lower limb. Typically, in the upper limb, we see the internal
rotation of the shoulder, flexion deformity of the elbow, pronation deformity
of the forearm, flexion deformity of the wrist and multiple variations of
finger and thumb deformities. In the early phase, Botox serves as an excellent
treatment modality to relax spastic muscles, before deformity becomes static.
The Botulinum Toxin binds to presynaptic cholinergic
nerve terminals selectively, preventing the ‘message’ from going through to the
muscle to contract. It prevents the neurotransmitter acetylcholine from being
released, preventing muscle contraction. Treatment is usually effective for
approximately 3-6 months.
There are other uses for in the upper limb like
axillary hyperhidrosis (overt sweating), spastic neck muscles as well as some
hand vascular conditions where Botox treatment could be effective.
Botox treatment generally requires a multidisciplinary
approach with physios and/or neurologists and even caregivers to balance the