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Child having wrist drop, flexion contractures. Tests reveal enlarged metacarpal heads. Try botox to release flexors?

I am a hand therapist who has a new patient 12 yrs old who presents with a wrist drop and flexion contractures . Mom states this was present at birth and has been functional up until now. She has seen 2 local orthopedic surgeons who have not given her a dx and recommended built up pencils to aid writing. His sensory is normal in the radial nerve distribution ( per Semmes -Weinstein.) He has a SIGNIFICANT /weakness of ECR, EDC,EIP,and EPL. He is unable to simultaneously extend wrist and fingers past neutral. Films reveal enlarged 2 nd and 3rd metacarpal heads. Is LLPS splinting worth trying? Is Botox a possibility to release the tight flexors. Is he a candidate for Tendon transfer? Thank you for your time!
Asked On : Mon, 25 Feb 2013
Answers:  1 Views:  102
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Pediatrician 's  Response
This seems to be a case of arthrogryposis, a picture may give better clue. Botox seems to be unrewarding if bony deformities coexist. Splints with oral muscle relaxants for a month may help improv therapy.
If the nerve conduction is defective then all is useless.
Ps: often orthopedic surgeons are reluctant for tendon transfers if muscle is degenerate.
Answered: Wed, 27 Feb 2013
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