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Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intramuscular neutrolysis with phenol has been used for 10 years in the management of spasticity in children. Best results depend on fastidious technique and realistic use of the procedure. Sedation or anesthesia was used in all cases -- 5% phenol in water was used for all procedures. The main indications were spasticity which interfered with function, either actual or potential, or with care. Where uninhibited vestibular or tonic neck reflexes affect muscle tone, or there is dystonia or athetosis, the procedure is less effective than where spasticity alone is present. Duration of relief of spasticity ranged from 1 month to more than 2 years. About one half of the lower extremity muscle treated required tenotomy later. Generally training was required after the procedure to obtain improved function. A representative sample of muscles treated, repeat procedures, and later surgery is discussed. The procedure is recommended for use in the management of spasticity in children as a way of improving function and/or care.
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PMID:Intramuscular neurolysis for spasticity in children. 47 67

Orthopedic management of the head trauma patient is divided into 3 phases--acute, recovery and stable. The treatment of bone injury is the main thrust in the acute phase. Guidelines were formulated from a retrospective review of 91 head trauma patients including spine and other fractures. The recovery phase consists of prevention and correction of joint deformities due to spasticity. Position, range of motion and splints are the basic methods employed. Indications and techniques for phenol injection to the posterior tibial and musculocutaneous nerves are reviewed. Heterotopic bone formation will be identified in this phase and treated early. In the final phase, one and one-half years postinjury, surgical treatment is employed to improve extremity function. Procedures proven of value in treatment of stroke patients are applicable. Heterotopic bone can also be definitively treated by excisional surgery supplemented by new medical agents.
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PMID:Orthopedic management of brain-injured adults. Part II. 65 7

The author gives a literature review of the management of spasticity carried out. Physical agents used such as ice, heat and vibration are described. Methods used by physical therapists are discussed. Drugs most commonly used in the treatment of spasticity are Diazepam, Baclofen and Dantrolene. Phenol has been used by injection into motor points, peripheral nerves and intrathecally. Other drugs that have been used are also discussed. Neurosurgical procedures include neurectomies, neurotomies, rhizotomies and more radical procedures such as myelotomies and cordectomies. Orthopaedic procedures involve muscle and tendon lengthening, release of contractures and tendon transfers. Surgery is discussed in terms of function. In considering the options, available care must be taken to achieve and maintain optimal functional level.
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PMID:The management of spasticity--a review of options available in rehabilitation. 129 22

Hip flexor spasticity, which is often associated with central nervous system (CNS) diseases, is a major impediment in rehabilitation. In order to cope with this problem, lumbar nerve blocking techniques developed by Meelhuysen and major and minor psoas muscle blocking techniques developed by Awad have been used in combination with physical therapies. Based on these techniques, we conducted major and minor psoas muscle phenol block (motor point block or intramuscular nerve block) under ultrasonic monitoring. Phenol block was conducted in nine patients with cerebral infarction (13 blocking procedures) and three with spinal cord injuries (six blocking procedures) while keeping them in a lateral position with the operation side upside. The beginning of the femoral nerves and part of the lumbar artery were visualized by ultrasound in some patients. As a result of the improvement of hip flexor spasticity, the range of hip joint motion (determined by the Mundale technique, prone hip extension and Thomas test) improved shortly after blocking. When physical therapy was conducted after blocking, improvement of skin care management was observed in eight cases, ability to keep in a stable sitting position in nine, improvement of a standing posture in three, increases in the ability to walk in two and alleviation of pain in three. Although nerve block is reported to result in hematoma, decreases in muscle force, pain, cystic/rectal disorders and hypogonadism, we have observed no such complication in our patients.
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PMID:Phenol block for hip flexor muscle spasticity under ultrasonic monitoring. 144 69

In this study an attempt was made to treat spinal cord injured patients with severe spasticity by peripheral nerve blocks. Thirty-six patients (5 female, 31 male) ranging in age from 20 to 71 years (mean: 29 +/- 8.2) were treated by phenol injections. A specially designed electrostimulation needle was used for the injections. The results showed that peripheral nerve blocks with phenol solution could be a remedy on a temporary basis, but are not as effective as has been described previously.
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PMID:Peripheral nerve block with phenol to treat spasticity in spinal cord injured patients. 148 35

Spasticity of the posterior calf muscles often occurs following head injury or spinal cord injury. If left untreated, equinovarus contractures of the foot and ankle may occur in a relatively short time period. This paper retrospectively reviews nine patients with either closed head injury (six patients) or spinal cord injury (three patients) who underwent open phenol injections into the motor branches of the tibial nerve in 16 limbs. Spasticity was decreased in all patients. No significant equinus contractures had occurred at final follow-up. Five of the patients were subsequently able to ambulate. One patient had recurrence of spasticity requiring a second surgical procedure (split anterior tibial tendon transfer), and two patients had significant toe clawing at final follow-up. Open phenol injections to the motor branches of the tibial nerve safely and effectively prevent foot and ankle contractures following spinal cord injury or head injury.
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PMID:The use of open phenol blocks to the motor branches of the tibial nerve in adult acquired spasticity. 185 7

Methods for detection and quantification of phenol have been developed primarily for use in environmental and industrial monitoring, given the widespread use of phenol as a disinfectant and antiseptic. Little information is available regarding concentrations of phenol in the blood of patients treated with phenol in regional nerve blocks (e.g., intrathecal) for temporary relief of pain or spasticity. We report a specific and sensitive method for quantifying phenol in plasma, using chemical derivatization and high-resolution capillary column gas chromatography in conjunction with mass spectrometry. The assay we describe was developed to monitor plasma concentrations of phenol in children given motor point nerve blocks with dilute phenol.
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PMID:Microtechnique for quantifying phenol in plasma by gas chromatography-mass spectrometry. 191 76

The treatment of spasticity in severely paralyzed patients undergoing rehabilitation constitutes a significant neurosurgical challenge that requires comprehensive management. In this study, 118 patients were treated with invasive modalities when medical therapy failed. The results of percutaneous radiofrequency foraminal rhizotomy were initially successful in 95% of the 77 patients who underwent this procedure; the rate of minor complications was 5%. This procedure was satisfactorily supplemented with percutaneous radiofrequency sciatic neurectomy in 32 of these 77 patients. Four myelotomies were performed with complete success and no major complications in patients in whom percutaneous techniques had proven inadequate. In 35 instances of focal spasticity and incomplete paralysis, intramuscular neurolysis by phenol injection was used. The success rate was 89%. In 9 patients with persistent recurrent spasticity of the lower limb, open tenotomies and peripheral neurectomies were done. Success was complete and without complications. Multiple modalities must be available for the comprehensive management of patients with paralytic spasticity.
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PMID:The management of paralytic spasticity. 230 79

Twenty-three extremities in 17 brain-injured adults were prospectively studied to evaluate the effectiveness of percutaneous phenol blocks of the musculocutaneous nerve in controlling spasticity of the biceps and brachialis muscles. Twenty-one (93%) of the extremities improved after the initial injection. The mean resting position decreased from 120 degrees of flexion to 69 degrees. Elbow range of motion increased an average of 53 degrees. There were no complications. Two patients did not respond to the initial injection and required repeat nerve blocks. Concomitant phenol motor point block of the brachioradialis muscle further improved elbow motion. The mean duration of the block was 5 months. Follow-up averaged 21 months. This study indicates that percutaneous phenol injection of the musculocutaneous nerve provides reliable, temporary relief of spasticity in patients with potential for further neurologic improvement.
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PMID:Percutaneous phenol block of the musculocutaneous nerve to control elbow flexor spasticity. 232 68

The subscapularis muscle is the primary internal rotator of the shoulder and plays a key role in causing adduction, internal rotation, and pain in the hemiplegic patient. Spasticity and pain can be reduced by performing motor point blocks to the subscapularis. Two patients with spastic hemiplegic shoulder showed reduction in pain and immediate improvement in external rotation, abduction, and flexion after phenol motor point blocks to the subscapularis muscle. This preliminary report describes a method of performing subscapularis motor point blocks using a medial scapular approach.
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PMID:Subscapularis motor point block for the painful hemiplegic shoulder. 233 91


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