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New Injection Points of Onabotulinum Toxin A for Spastic Paralysis of the Fingers: Eight Cases of Report

Objective: Onabotulinum toxin A (botulinum A toxin) is utilized to extend flexed extremities in spastic hemiparesis. Injection points are important to obtain a better effect. Injecting botulinum A toxin into the forearm muscles is a standard method for flexed wrist and fingers; however, we developed new injection points in the intrinsic muscles of the hand to acquire more reliable effect. Methods: The authors injected botulinum A toxin into the palmar side of the proximal and middle phalanx of each finger and thenar muscles. Eight patients with poststroke flexed wrist and fingers were treated by this method. Results: In all patients, the spasticity improved to 0 or 1 from 3 or 4 in Modified Modified Ashworth Scale 1 month after the treatment. They were satisfied with our treatment because they could keep their affected fingers hygienic by washing fingers cleanly after the treatment. Conclusions: Our botulinum A toxin injection points for finger spastic paralysis are accurate spots producing great effect to flexed fingers.