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Healing hand ulcers caused by focal spasticity
Anupam D Gupta1, Samantha Addison1
1Department of Rehabilitation Medicine, The Queen Elizabeth Hospital, University of Adelaide, Woodville South, South Australia, Australia.
International Wound Journal
|March 6, 2020
Summary
Botulinum toxin A injections effectively healed treatment-resistant hand ulcers in spasticity patients. This approach improved pain, hand function, and reduced carer burden, offering a new treatment strategy.
Area of Science:
- Neurology
- Dermatology
- Rehabilitation Medicine
Background:
- Spasticity from upper motor neuron lesions (stroke, TBI, MS) can cause severe hand ulcers.
- Treatment-resistant hand ulcers present significant pain, hygiene challenges, and carer burden.
Purpose of the Study:
- To evaluate the efficacy of Botulinum toxin A (BoNTA) combined with standard care for treatment-resistant hand ulcers in spastic patients.
- To assess improvements in spasticity, ulcer healing, pain, hand function, and carer burden.
Main Methods:
- Ten nursing home residents with long-standing, treatment-resistant hand ulcers due to spasticity were treated.
- Intervention involved Botulinum toxin A injections into spastic hand muscles, followed by dressing, splinting, and hand therapy.
Main Results:
- Complete ulcer healing was observed in all patients.
- Significant improvements were noted in Modified Ashworth Scale (spasticity), Visual Analog Scale (pain), ulcer grade, hand opening (Fingertip to Palm distance), Carer Burden Scale, and Goal Attainment Scale (P < .005).
Conclusions:
- Botulinum toxin A injection is a crucial first step for managing hand ulcers caused by focal spasticity.
- This multimodal approach significantly improves patient outcomes and quality of life.
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