The Efficacy of Ultrasound-guided Selective Botulinum Toxin Type A Therapy for Finger Spasticity Following Stroke : A Case Report

A 64-year-old man had spasticity of digits 3 and 4 of the right hand for 22 years following a stroke. Activities of daily living (ADL) were impaired due to the disuse of the right arm. The flexor digitorum superficialis and flexor digitorum profundus muscles of digits 3 and 4 of the patient's right forearm were identified using ultrasound guidance, and botulinum toxin type A was selectively injected into those sites. Furthermore, following the injections, occupational therapy was performed for the right arm and fingers, and spasticity was assessed after 2 weeks and at 1, 2, 3, 4, and 5 months. The patient showed improvement in all the evaluations (the Modified Ashworth Scale, Disability Assessment Scale, functional independence measure, active range of motion angle, and movement of holding a cup), and function was maintained throughout the evaluation period. Performing botulinum toxin type A injection under ultrasound guidance to selectively identify the flexor digitorum superficialis and flexor digitorum profundus muscles involved in finger spasticity helped restore finger functioning and improve ADL.