Role of botulinum toxin in hand and upper limb disorders relevant to hand therapy

Abstract

Introduction. This article reviews the mechanism of action of botulinum toxin and provides an overview of its use in hand disorders relevant to hand therapy such as hyperhidrosis, spasticity, dystonia, tremor, Parkinson's, obstetrical brachial plexus palsy, flexor tendon rehabilitation, lateral epicondylitis, Raynaud's and carpal tunnel syndrome. Methods. A narrative review of the literature retrieved through electronic databases using keywords botulinum toxin, hand, therapy, and reviewing the bibliographic references cited. Results. Sixty-five original articles and meta-analyses were reviewed. The number and quality of the published reports for each disorder are very variable but generally botulinum toxin is reported to be an effective adjunct to therapy in the treatment of a wide variety of hand and upper limb pathologies. Discussion. A surprising number of hand and upper limb conditions have been successively treated with botulinum toxin, but most require botulinum toxin to be used in conjunction with hand therapy to achieve more effective outcomes for longer duration. Neuromuscular disorders seem to be most responsive to botulinum toxin treatment. Therapists should be aware of the potential benefits of botulinum toxin injections for a wide range of hand disorders and when appropriate discuss these with patients and other health professionals. Conclusion. Botulinum toxin has an effective and growing role in hand therapy.

Role of botulinum toxin in the management of hand ulceration due to post-stroke spasticity among aged care residents

“…BoNTA is useful in many disorders of the hand, such as spasticity, dystonia, hyperhidrosis, tremor and Raynaud's phenomenon. 22 Interestingly, several mechanisms of BoNTA are likely to be operational in the healing of hand ulcerations.…”

Effectiveness of BoNT A in Parkinson's Disease Upper Limb Tremor Management

“…Since tremor is often asymmetric and focal, medications used for treatment of focal disorders such as botulinum toxin could be beneficial in the treatment of PD tremor [9][10][11][12] . Botulinum toxin type A and B have been well established for the treatment of focal dystonia, with type A demonstrating generally longer duration and better effect 13,14 .…”