Upper limb spasticity (ULS) is a common condition that occurs in stroke survivors, affecting nearly 60 percent of survivors.
ULS causes muscle stiffness at the elbow, wrist and fingers which may cause you to have an arm locked in a position that cannot be straightened without force and great pain.
It may cause your hand to be tightly clenched in a fist, or your arm to be pinned against your chest.
What Causes Spasticity?
Damage caused by stroke to the areas of the brain that control voluntary movements causes ULS, leading to the brain to overcommunicate with muscles in the elbow, wrist or fingers, giving them constant instruction to contract. These signals to tighten cause the disability of ULS.
While it is not life-threatening, it can cause functional disability in stroke survivors.
Signs & Symptoms
Spasticity has a number of signs and symptoms, including:
- Stiffness in the extremities, arms and legs
- Painful muscle spasms
- Abnormal posture
- Hyper-responsive reflexes
- Increased muscle rigidity
- Clonus, or uncontrollable movement, in a series of involuntary contractions and relaxations in a muscle or muscle group
The most common treatment for spasticity involves a combination of physical therapy and medications.
Your doctor will tailor the appropriate treatment to your needs, and will help you understand the nature of any side effects that may result from treatment.
Physical therapy for spasticity includes:
- Range-of-motion exercises at least three times daily
- Stretching of tighter muscles
- Routine repositioning of affected limbs
There are a number of drugs that can be taken to treat the effects of spasticity, whether through oral, intravenous or Intrathecal administration.
Oral medicines include drugs that act on multiple muscle groups in the body, such as:
- Baclofen™: Oral baclofen works on the central nervous system, causing muscles to relax. It is not for patients with spasticity caused by problems within the brain. It decreases the rate of pain and muscle spasms, as well as tightness and improves the limb’s range of motion
- Benzodiazepines (Valium® and Klonopin®): These drugs can temporarily relax muscles and decrease spasticity by acting on the central nervous system, and have a sedative effect on patients with stroke
- Dantrolene sodium (Dantrium®): This drug blocks the signals that causes muscle contractions
- Tizanidine (Zanaflex™): This drug reduces spasticity temporarily by blocking nerve impulses to the muscles
Two intravenous (or injection) drugs that may be used to treat spasticity are Botox® and phenol.
- Botulinum toxin (Botox®, Myobloc®, Dysport®): Use of this substance, specifically targeting affected limbs, prevents the release of chemical signals that cause muscles to contract
- Phenol: Used within a specific muscle group, phenol destroys neural pathways that are involved with spasticity, and can provide relief from six to 36 months
A liquid form of Baclofen™ may be administered directly into the patient’s spinal fluid by means of a portable, programmable pump which constantly delivers small doses of the medicine.
In some cases, surgery may be performed to the affected muscles, blocking pain receptors and allowing the restoration of some movement.