title: Botulinum toxin injection of spastic finger flexors in hemiplegic patients.
abstract: OBJECTIVE
  To assess the outcomes of botulinum toxin injection of spastic finger flexors followed by intensive training of finger extensors.
  
  
  METHODS
  Fourteen subjects with chronic hemiplegia spasticity of the upper limb had electromyographic-guided botulinum toxin injection into the long finger flexors. All patients presented with minimal active finger extension with the wrist flexed, sustained clonus of the finger flexors, functional proximal arm function, and absence of fixed contracture. Cadaver dissections directed selection of two injection sites: the flexor digitorum sublimis and the flexor digitorum profundus. Fifty mouse units of botulinum toxin were injected into each muscle. After injection, the subjects were instructed in a home program of stretching the long finger flexors, upper limb weight bearing with a weight-bearing splint, and exercise to improve finger extension control.
  
  
  RESULTS
  Compared with preinjection measures, assessment the first week after the initial injection showed significantly reduced tone, reduced clonus, and greater active finger extension with the wrist in the neutral position. Four months later, the Ashworth scale increased to preinjection levels in the six subjects with repeated injections but was again decreased postinjection. Active finger extension with the wrist in the neutral position and clonus showed a statistically nonsignificant trend toward cumulative improvement after the second injection.
  
  
  CONCLUSIONS
  The greatest change in finger extension and spasticity reduction occurred after the first injection. Continued significant improvement in finger extension was not observed.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Rodriquez
authors.forename: M
authors.initials: M
authors.lastname: McGinn
authors.forename: R
authors.initials: R
authors.lastname: Chappell
mesh_terms: D000328:Adult; D000368:Aged; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000627:therapeutic use*; D004576:Electromyography; D005081:Exercise Therapy; D005385:Fingers; D006429:Hemiplegia / Q000150:complications*; D006801:Humans; D007273:Injections, Intramuscular; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology / Q000534:rehabilitation; D011597:Psychomotor Performance; D016896:Treatment Outcome
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins