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

Abstract

Individuals with significant post-stroke impairments often move to residential care. The prevalence of spasticity is high among these residents. Palmar ulceration is an under-recognised complication of unmitigated post-stroke hand spasticity. The ulcerations are painful, emit offensive smell and cause significant suffering for the individuals and the carers. The aim of this article is to discuss the healing of these ulcerations by reducing spasticity in the hand muscles with botulinum toxin A (BoNTA) injection followed by dressing, splinting and hand therapy. This article discusses the epidemiology, anatomy and clinical presentations of spastic hand ulcerations and mechanisms of action of BoNTA in alleviating the ulcers and related symptoms such as pain, sweating, offensive smell, and lessening the carer burden. The primary neuromuscular blocking action of BoNTA results in the opening of the hand, allowing dressing and ease of care. The toxin provides pain relief, inhibits excessive sweat production and causes vasodilatation, ultimately resulting in healing of the ulcerations.