The Clinical Efficacy of Botulinum Toxin Injections to the Upper Lumbrical Muscles for Clenched Fist Deformity in Chronic Stroke Patients.

[OBJECTIVE] Post-stroke hemiplegic patients with a spastic clenched fist deformity that was caused by upper motor neuron syndrome often have problems with hygiene and nursing. Botulinum toxin-A (BTX-A) had been given for treatment of such patients to relieve spasticity by targeting finger joint muscles, such as the flexor digitorum superficialis and flexor digitorum profundus. However, some of these patients do not have satisfactory outcomes. Therefore, we aimed to examine the clinical efficacy and outcome of BTX-A treatment that targeted the upper lumbrical muscles (ULM) in patients with spastic clenched fist deformity caused by stoke.

[METHODS] Chronic stroke patients with spastic clenched fist deformity who received BTX-A treatment were evaluated retrospectively. We obtained data from medical records before and at 4 weeks after BTX-A injection to the ULM. The clinical data and outcome measures analyzed included range of motion, the Modified Ashworth Scale, the numeric graphic rating scale for pain, and 2 items from the disability assessment scale (ease of cleaning palm and trimming nail).

[RESULTS] Wilcoxon signed rank test showed that BTX-A treatment significantly improved all measures.

[CONCLUSION] BTX-A therapy to the ULM provided satisfactory outcomes in improving spastic clenched fist.