Multidisciplinary management of pain and function in a patient with bilateral thumb hypoplasia undergoing multiple reconstructive procedures

Abstract

Congenital thumb hypoplasia impairs hand function. Surgical reconstruction may cause long-term muscle overload and chronic pain. A 33-year-old woman with a history of bilateral thumb hypoplasia, treated during childhood, developed myofascial pain. Ultrasound examination confirmed trigger points and hypertrophy in the brachialis and finger flexor muscles. Injections of botulinum toxin type A (BoNT-A, 60U) reduced pain by 60% for four months without compromising functional capacity. Biomechanical adaptations post-reconstruction cause myofascial pain. BoNT-A is effective. BoNT-A aids pain management in thumb reconstruction. Ultrasound enhances diagnosis.

Keywords: Botulinum toxins type A; Ecografía; Myofascial pain syndromes; Plastic surgery procedures; Procedimientos de cirugía plástica; Pulgar hipoplásico; Síndromes de dolor miofascial; Thumb hypoplastic; Toxina botulínica tipo A; Ultrasonography.