Introduction

Patients with spinal cord injury (SCI) and incomplete paralysis may experience muscle immobilization due to functional impairment of agonist and antagonist muscles. This can induce spasticity and pain, with the risk of contracture increasing as the period of immobilization increases. This could be aggravated by pain, which interferes with rehabilitation. There is no established treatment for pain and joint contractures caused by acute SCI. Botulinum therapy plays a role in relieving muscle tension. Here, we report a case of acute SCI in which botulinum therapy was administered.

Case presentation

The patient experienced a C5-cervical SCI due to a road traffic accident, with marked paralysis in the upper and lower limbs below the C5 level. The patient had persistent elbow flexion since the SCI and complained of excruciating pain, making adequate rehabilitation difficult. Botulinum toxin was administered to the biceps and brachialis muscles 15 days after the SCI. After administration, the patient experienced a reduction in pain with relaxation of the elbow flexor muscles, and rehabilitation treatment was resumed. This patient’s contracture did not worsen, his pain decreased, and he was able to initiate self-feeding training.

Discussion

In this case, occupational and physical therapy was administered with botulinum therapy. Together, they successfully reduced pain. Botulinum therapy provides analgesia and muscle relaxation and may lead to functional recovery, and we believe that treatment can be considered even in the acute phase.

中文翻译：

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上肢肉毒杆菌毒素联合康复治疗急性脊髓损伤一例报告

介绍

脊髓损伤 (SCI) 和不完全瘫痪患者可能会因主动肌和拮抗肌功能受损而出现肌肉固定。这会引起痉挛和疼痛，随着固定时间的增加，挛缩的风险也会增加。疼痛可能会加剧这种情况，从而影响康复。目前尚无针对急性 SCI 引起的疼痛和关节挛缩的既定治疗方法。肉毒杆菌疗法起到缓解肌肉紧张的作用。在此，我们报告一例接受肉毒杆菌治疗的急性 SCI 病例。

案例展示

患者因道路交通事故发生C5颈椎脊髓损伤，C5水平以下上下肢明显瘫痪。自脊髓损伤以来，患者的肘部持续屈曲，并抱怨难以忍受的疼痛，使得康复变得困难。 SCI 后 15 天，对二头肌和肱肌注射肉毒杆菌毒素。给药后，患者疼痛减轻，肘屈肌松弛，并恢复康复治疗。该患者的挛缩没有恶化，疼痛减轻，并且能够开始自我进食训练。

讨论

在这种情况下，职业和物理治疗与肉毒杆菌疗法一起进行。他们一起成功减轻了疼痛。肉毒杆菌疗法可提供镇痛和肌肉松弛作用，并可能导致功能恢复，我们认为即使在急性期也可以考虑治疗。