title: Botulinum toxin use as an adjunctive modality in a patient with multiple flexor tendon ruptures.
abstract: Botulinum toxin A has been described in treatment protocols for several disease processes, from primary axillary hyperhydorosis to esophageal dysfunction. It is best known for its use in plastic and dermatological practices. Botulinum toxin has a straightforward mechanism of action. The toxin inhibits acetylcholine release at the neuromuscular junction causing a chemical denervation, which ceases contractions of the muscle. With its minimal side effect profile, botulinum toxin should be considered when muscle spasm is a detriment. This case involves an injury to the hand of a patient with a history of intermittent diffuse muscle spasms. Subsequently, due to the patient's previous upper extremity muscle spasms, repeated flexor tendon repair ruptures of the index finger occurred until botulinum toxin was administered to the offending muscle. The patient has not required any additional surgical interventions for the repaired tendon and is now actively flexing all digits. This case report demonstrates how botulinum toxin can be used in a clinical scenario when decreased muscle activity is desired to promote tendon healing.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University, The Philadelphia Hand Center, 834 Chestnut Street, Suite G114, Philadelphia, PA, 19107, USA. wj.kubat@verizon.net.
authors.forename: Wade D
authors.initials: WD
authors.lastname: Kubat
authors.forename: Mark
authors.initials: M
authors.lastname: Rekant
references.citation: Paediatr Drugs. 2003;5(1):11-23
references.pmid: 12513103
references.citation: Arch Phys Med Rehabil. 2007 Jan;88(1):1-10
references.pmid: 17207668
references.citation: Am J Phys Med Rehabil. 2000 Jan-Feb;79(1):44-7
references.pmid: 10678602
references.citation: Dev Med Child Neurol. 1997 Mar;39(3):185-93
references.pmid: 9112968
references.citation: N Engl J Med. 2002 Aug 8;347(6):395-400
references.pmid: 12167681
references.citation: J Pediatr Orthop. 2004 Nov-Dec;24(6):629-33
references.pmid: 15502560
references.citation: Eur J Neurol. 2006 Feb;13 Suppl 1:30-5
references.pmid: 16417595