Botulinum Toxin Injection for Painful Adductor Pollicis Contracture after Thumb Carpometacarpal Resection Arthroplasty
Round 1
Reviewer 1 Report
In this Case-report, the authors describe their experience with the treatment of a symptomatic adductor pollicis contracture after carpometacarpal resection arthroplasty by using botulinum toxin.
Although the effect was of limited time, the benefit for the patient was obvious.
Adductor pollicis contracture after carpometacarpal resection arthroplasty is a relevant topic.
This treatment option is, although not a standard of care and in literature underrepresented, an interesting option.
The manuscript is well written and structured. It covers the most relevant issues. The cited references are mostly current without abnormal number of self-citations.
As the topic is interesting, the manuscript is scientifically sound.
Author Response
In this Case-report, the authors describe their experience with the treatment of a symptomatic adductor pollicis contracture after carpometacarpal resection arthroplasty by using botulinum toxin.
Although the effect was of limited time, the benefit for the patient was obvious.
Adductor pollicis contracture after carpometacarpal resection arthroplasty is a relevant topic.
This treatment option is, although not a standard of care and in literature underrepresented, an interesting option.
The manuscript is well written and structured. It covers the most relevant issues. The cited references are mostly current without abnormal number of self-citations.
As the topic is interesting, the manuscript is scientifically sound.
We would like to thank the reviewer for his/her time to review our manuscript and expressing his praise for our work. We very much appreciate it.
Reviewer 2 Report
The following is the summary of the present manuscript:
Pollux adductus deformity is considered as an accompanying symptom of thumb carpometacarpal osteoarthritis. We describe a case of a patient who presented with increased muscle tone of the adductor pollicis muscle and chronic pain in the thenar musculature. The patient reported a symptom-free period of 5.5 years after having received resection-suspension-arthroplasty for stage IV thumb carpometacarpal osteoarthritis until the spasmodic pain appeared. Due to the functional impairment of this condition, we performed a therapy including 100 Units of Botox® (onabotulinumtoxinA, Allergan, Dublin, Ireland) injected with a fanning technique into the adductor pollicis muscle. Thus, we could observe a substantial improvement of the patient-reported outcome measures as well as pain levels compared to initial values. The current case shows the pivotal role of the adductor pollicis muscle when patients report pain at the base of the thumb and that it can cause a considerable impairment despite of a complication-free surgical treatment of thumb CMC OA.
The case is interesting. In this study, the authors used the landmark guiding technique to perform the injection. However, the technique may cause damage to the recurrent motor branch of the median nerve. Please refer to the following case report:
https://pubmed.ncbi.nlm.nih.gov/34015071/
Recently, ultrasound can clearly delineate the thenar muscle and the method has been clearly described in a scanning protocol (https://pubmed.ncbi.nlm.nih.gov/28264546/). I strongly encourage the authors to use ultrasound for injections of the thenar muscle in the future.
Author Response
The case is interesting. In this study, the authors used the landmark guiding technique to perform the injection. However, the technique may cause damage to the recurrent motor branch of the median nerve. Please refer to the following case report:
https://pubmed.ncbi.nlm.nih.gov/34015071/
We thank the reviewer for his/her effort to comment on our manuscript. Especially, we would like to thank the reviewer for suggesting this interesting case presenting an injury to the recurrent motor branch of the median nerve after injection therapy. Thus, we have included this issue in the discussion section.
Recently, ultrasound can clearly delineate the thenar muscle and the method has been clearly described in a scanning protocol (https://pubmed.ncbi.nlm.nih.gov/28264546/). I strongly encourage the authors to use ultrasound for injections of the thenar muscle in the future.
We thank the reviewer for sharing this valuable review paper covering ultrasound guided injection methods into various upper limb muscles. In a further consequence, we will apply the presented image guided injection technique into the AP muscle for our further planned series of patients.
