Kiran Dhaliwal1,2,3,4,5, Michelle F Griffin6,7,8,9,10, Sebastian Salinas1,2,3,4,5, Kevin Howell1,4,11, Christopher P Denton1,4,11, Peter E M Butler1,2,3,4,5. 1. Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, UK. 2. UCL Centre for Nanotechnology and Regenerative Medicine, London, UK. 3. Division of Surgery & Interventional Science, University College London, London, UK. 4. Royal Free Hospital, London, UK. 5. Plastic & Reconstructive Surgery, Royal Free Hospital, London, UK. 6. Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, UK. 12michellegriffin@gmail.com. 7. UCL Centre for Nanotechnology and Regenerative Medicine, London, UK. 12michellegriffin@gmail.com. 8. Division of Surgery & Interventional Science, University College London, London, UK. 12michellegriffin@gmail.com. 9. Royal Free Hospital, London, UK. 12michellegriffin@gmail.com. 10. Plastic & Reconstructive Surgery, Royal Free Hospital, London, UK. 12michellegriffin@gmail.com. 11. Center for Rheumatology, UCL Division of Medicine and Royal Free London NHS Foundation Trust Hospital, London, UK.
Abstract
INTRODUCTION: Raynaud's phenomenon (RP) is a common condition and causes pain, paraesthesia, ulceration and gangrene. Botulinum toxin A (Btx-A) is effective when injected via a digital palmar approach, in the treatment of severe RP. However, hand weakness resulting from lumbrical malfunction is a recognized complication. This study aimed to determine the effect of Btx-A injected via a dorsal approach. METHOD: Forty patients received 100 units of Btx-A, injected across both hands via a dorsal approach. Each patient had a baseline, 6- and 12-week hand assessment and thermographic image (FLIR E60bx) performed for the study. RESULTS: Eighty-eight percent of patients reported an improvement in symptoms including reduction in pain, improved colour change with reduced swelling and edema at 6 weeks. Of these patients, 80% reported an improvement in cold intolerance with a reduction in the frequency and severity of Raynaud's attacks. There was a significant improvement in both the DASH score (p = 0.001), Kapandji score (p = 0.001) and hand strength (p < 0.05). No patients reported weakness. Improvements in hand function and symptoms of RP were still evident at 12 weeks. CONCLUSIONS: Btx-A injected via a dorsal approach improves symptoms and reduces the number of RP. We have shown an effective non-surgical approach technique to treat RP.Key Points• Raynaud's phenomenon is a common vasospastic disorder of the digital vessels, which can cause severe pain, restrictions to hand function and ulceration.• Dorsal botulinum toxin type A injections can improve the symptoms of secondary Raynaud's phenomenon and hand function for approximately 3 months.
INTRODUCTION: Raynaud's phenomenon (RP) is a common condition and causes pain, paraesthesia, ulceration and gangrene. Botulinum toxin A (Btx-A) is effective when injected via a digital palmar approach, in the treatment of severe RP. However, hand weakness resulting from lumbrical malfunction is a recognized complication. This study aimed to determine the effect of Btx-A injected via a dorsal approach. METHOD: Forty patients received 100 units of Btx-A, injected across both hands via a dorsal approach. Each patient had a baseline, 6- and 12-week hand assessment and thermographic image (FLIR E60bx) performed for the study. RESULTS: Eighty-eight percent of patients reported an improvement in symptoms including reduction in pain, improved colour change with reduced swelling and edema at 6 weeks. Of these patients, 80% reported an improvement in cold intolerance with a reduction in the frequency and severity of Raynaud's attacks. There was a significant improvement in both the DASH score (p = 0.001), Kapandji score (p = 0.001) and hand strength (p < 0.05). No patients reported weakness. Improvements in hand function and symptoms of RP were still evident at 12 weeks. CONCLUSIONS: Btx-A injected via a dorsal approach improves symptoms and reduces the number of RP. We have shown an effective non-surgical approach technique to treat RP.Key Points• Raynaud's phenomenon is a common vasospastic disorder of the digital vessels, which can cause severe pain, restrictions to hand function and ulceration.• Dorsal botulinum toxin type A injections can improve the symptoms of secondary Raynaud's phenomenon and hand function for approximately 3 months.