Bad Raynaud’s? – Botox It.

Raynaud’s phenomenon responds to Botulinum injection of neurovascular metacarpal bundles. Can get occasional temporary finger weakness (max 2-3 months)  though. Pain relief can last few months to more than 6 year

Minimally Invasive Treatment of Raynaud Phenomenon The Role of Botulinum Type A
Michael W. Neumeister, Kelli Nicole Belangee Webb, Michael Romanelli
Hand Clin 30 (2014) 17–24

  • Studies have shown 75-100% relief of pain and 49-100% of ulcers healing.

Technique:

  • dilute 100 units in 10 mls saline
  •  inject 2 mL “around each neurovascular bundle at the level of the bifurcation of the common digital vessels around the MCP joint”
  • Inject only symptomatic fingers

  • 16–27% got temporary intrinsic muscle  finger weakness
  • duration pain relief averaged 23.4 months

Comment – not a FDA indication so probably patient pays.

addendum:

in more end stage scleroderma, botulinum failed to make a difference but at that stage, not surprising:

Arthritis Rheumatol. 2017 Apr 20. doi: 10.1002/art.40123. [Epub ahead of print]
The Therapeutic Efficacy of Botulinum Toxin in Treating Scleroderma-Associated Raynaud’s Phenomenon: A Randomized, Double-Blind, Placebo-Controlled Clinical
Trial Assessing.
Bello RJ et al
https://www.ncbi.nlm.nih.gov/pubmed/28426903

 

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