This article features a discussion about how to approach treatment for a hypothetical clinical case of a thirty-four-year-old patient who had suffered a left hemorrhagic cerebral vascular accident 6 months ago resulting in right hemiparesis. The patient presented with progressive right-hand tightness and pain onset over the previous 2 months and had received multiple outpatient physical and occupational therapy visits without benefit.
The purpose of this article is to consider this commonly-encountered treatment challenge and to contrast two different approaches, in terms of dosage and injection techniques. More importantly, it will highlight the variety of potential options available and encourage further discussion and exchange of expertise, thereby enhancing future patient care.