gms | German Medical Science

Objectives/Interrogation: Among patients with systemic sclerosis Raynaud's phenomenon (RP) is common causing pain, paraesthesia, ulceration, and gangrene. Botulinum toxin A (Btx-A) can be an effective treatment for RP when injected via a digital palmar approach. However, this technique can cause hand weakness resulting from lumbrical malfunction. This study aimed to determine the effect of Btx-A injected via a dorsal innovative approach to treat RP, limiting potential complications and to improve efficacy.

Methods: Thirty-eight patients received 100 units of Btx-x injected into both hands via a dorsal approach. Each patient had a baseline and 6-week hand assessment and thermographic image (FLIR E60bx).

Hand assessment included pinch and power grip strength measurements (Jammar plus digital pinch gauge and dynameter), range of movement using a goniometer, Kapandji thumb opposition test and a pain score using the visual analogue scale (VAS score 0-10). Patients were asked to report any symptoms of pain, colour change, cold intolerance on a weekly basis. Furthermore patients were asked to complete a Disabilities of the Arm, Shoulder and Hand (DASH) score. Post injection, the hand assessment and thermography was performed at 15 minutes and at 6 weeks in a temperature controlled room at 23.7 +/- 2oC.

Results and Conclusions: Eighty-eight percent of patients reported an improvement in symptoms with a decrease in pain, swelling and improve colour change. Furthemore, 80% reported an improvement in cold intolerance with a decrease in their frequency and severity of Raynaud's attacks (p < 0.01). There was also an significant improvement in both the DASH score (p = 0.001), Kapandji score (p=0.001) and Hand strength (p<0.05) after 6 weeks. No patients reported any weakness at 6 weeks. There was a significant mean increase in the temperature of all fingers after 6 weeks compared to baseline(p < 0.05). There was also a significant increase in the range of movement in all joints post Btx-A injection (p < 0.05). There were no complications with the innovative approach.

Btx-A injected via a dorsal approach improves symptoms and hand function of RP secondary to systemic sclerosis. We have shown an effective and safe surgical technique to treat RP in systemic sclerosis patients that can be delivered in an outpatient setting.