['scleroderma', "raynaud's syndrome"]
['onabotulinumtoxin a', 'sterile saline solution']

        Inclusion Criteria:

          -  Aged 18 years and older

          -  Diagnosed with scleroderma.

          -  Symptoms of Raynaud's syndrome affecting both hands (not necessarily to equal extents)

          -  Ability to return/be available for follow-up evaluations

          -  Able and willing to give informed consent

          -  Able to speak and read in the English language.

        Exclusion Criteria:

          -  A history of Myasthenia gravis.

          -  Reported allergy or hypersensitivity to any Botulinum toxin preparation.

          -  Active infection in either hand.

          -  Patients who have ever received Botulinum toxin vaccine.

          -  Pregnant or lactating women.

          -  Females unable or unwilling to maintain abstinence or use contraception for 28 days
             following the injections.

          -  Patients who have previously undergone any vascular surgery on the upper extremity,
             including surgical sympathectomies.

          -  Current use of any aminoglycoside antibiotic
      