Healing hand ulcers caused by focal spasticity.

International Wound Journal
Anupam D Gupta, Samantha Addison

Abstract

Spasticity is a common manifestation of many upper motor neuron lesions such as stroke, traumatic brain injury, and multiple sclerosis. In some cases, spastic fingers in the hand press hard into the palm, resulting in skin breakdown and atypical pressure ulcerations. We treated 10 such patients living in the nursing homes with long-standing treatment-resistant hand ulcers in our spasticity clinic first, with Botulinum toxin A (BoNTA) injection into the spastic muscles followed by dressing, splinting, and hand therapy. These ulcers failed to respond to standard treatment, causing significant pain, offensive smell, increased carer burden, and difficulty in maintaining hygiene as hands could barely be opened for dressing and therapy. We noted complete healing of ulcers with significant improvement in the following outcome measures-Modified Ashworth Scale for spasticity, Visual Analog Scale for pain, pressure ulcer grading for the ulcers, Fingertip to Palm distance for hand opening, Carer Burden Scale, and in the Goal Attainment Scale pre, 4 weeks, and 3 months postinjection with P values of .003, .003, .004, .005, .004, and .004, respectively. Reducing spasticity with BoNTA should be the first step in treating hand ulcerations cau...Continue Reading

References

May 26, 2006·International Wound Journal·Bishara S Atiyeh, Shady N Hayek
Apr 4, 2008·The Journal of Neuroscience : the Official Journal of the Society for Neuroscience·Flavia AntonucciMatteo Caleo
Apr 24, 2012·Journal of the American Medical Directors Association·Kuen LamChristine Leung
Feb 5, 2013·International Wound Journal·Efraim Jaul
Dec 3, 2014·Hand Clinics·Michael W Neumeister
May 17, 2018·The Medical Journal of Australia·Anupam Datta Gupta, David H Wilson
Jun 3, 2018·Toxins·Jihye Park, Myung Eun Chung
Mar 22, 2019·International Wound Journal·Efraim JaulOded Meiron
Dec 14, 2019·The Medical Journal of Australia·Anupam Datta Gupta, David H Wilson

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Citations

Apr 6, 2021·Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists·Ishan RadotraStuart W McKirdy

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