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

Spasticity that interferes with upper extremity function is common in adults following stroke, brain injury, or anoxia. During the period of neurologic recovery definitive surgical procedures are avoided. Techniques to temporarily reduce spasticity include the implantation of a MicroPort reservoir and catheter for repeated branchial plexus blocks and phenol nerve blocks, which provide longer lasting relief of noxious muscle tone. Percutaneous blocks of the musculocutaneous and recurrent median nerves and motor point blocks of the pectoralis major, the brachioradialis, and forearm flexor muscles are easily performed at bedside. The motor branch of the ulnar nerve can be injected surgically with phenol to diminish intrinsic spasticity. When neurologic recovery has plateaued, hand placement can be improved in many patients following proximal release of the brachioradialis muscle and lengthening of the biceps and branchialis tendons. Hand function is enhanced by fractional lengthening of spastic wrist and finger flexors. Intrinsic spasticity must be addressed at the same time by phenol block or intrinic release. When extensor function is lacking, a tenodesis of the wrist extensors is helpful. The thumb-in-palm deformity requires proximal release of the thenar muscles as well as lengthening of the flexor pollicis longus. Contracture releases in the nonfunctional arm improve hygiene and ease care.
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PMID:Management of the spastic upper extremity in the neurologically impaired adult. 304 30

Ninety-two tibial nerve blocks with phenol were performed in 59 patients for treatment of severe spasticity of the foot. The Achilles tendon reflex was abolished, ankle clonus was eliminated and resistance to passive stretch was reduced substantially following the procedure in all patients. Significant functional gains were observed as a result of decrease in spasticity with long-term follow-up averaging 28.7 months (range 14-60). The simplicity of the procedure, the functional results observed with long-lasting effects, and the lack of serious complications, would suggest the more widespread use of this procedure in the treatment of the spastic foot.
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PMID:Phenol block of the tibial nerve for spasticity: a long-term follow-up study. 318 73

The functional impairment due to spasticity must be carefully assessed before any treatment is considered. Therapeutic intervention is best individualized to a particular patient. Basic principles of treatment to ameliorate spastic hypertonia are: 1) avoid noxious stimuli and 2) provide frequent range of motion. Therapeutic exercise, cold or topical anesthesia may decrease reflex activity for short periods of time in order to facilitate minimal motor function. Casting and splinting techniques are extremely valuable to extend joint range diminished by hypertonicity. Baclofen, diazepam and dantrolene remain the three most commonly used pharmacologic agents in the treatment of spastic hypertonia. Baclofen is generally the drug of choice for spinal cord types of spasticity, while sodium dantrolene is the only agent which acts directly on muscle tissue. Phenytoin with chlorpromazine may be potentially useful if sedation does not limit their use. Tizanidine and ketazolam, not yet available in the United States, may be significant additions to the pharmacologic armamentarium. Intrathecal administration of antispastic medications allows high concentrations of drug near the site of action, which limits side effects. This form of treatment is the most exciting recent development in the treatment of spastic hypertonia. Peripheral electrical stimulation may have limited use in diminishing tone and facilitating paretic muscles. Dorsal column stimulation via electrodes within the spinal column was initially hailed as a therapeutic advance, but has subsequently been shown to be minimally effective. Phenol injections provide a valuable transition between short-term and long-term treatments and offer remediation of hypertonia in selected muscle groups. Tenotomies and tendon transfers offer significant benefit in carefully chosen patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Management of spasticity. 328 46

Thirty-nine adults with acquired spastic disorders who had 21 phenol injections and 21 neurectomies of the motor branch of the ulnar nerve in Guyon's canal for control of intrinsic spasticity in the hand were reviewed. Follow-up averaged 25.8 months for the patients with phenol blocks and 24.3 months for those who had a neurectomy. Intrinsic spasticity was relieved in all hands postoperatively. After the phenol block, which is a temporizing procedure, 13 hands had return of spasticity in 6 months. Eight hands had little or no return of spasticity and required no further treatment. Neurectomy was performed in predominantly nonfunctional hands with severe hygiene problems and with no potential for further neurologic recovery. Hand function was improved in six hands after phenol block and in one hand after neurectomy. Hygiene was improved in all hands after phenol block and in all except one hand after neurectomy. Two wound infections and one wound dehiscence occurred.
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PMID:Management of intrinsic spasticity in the hand with phenol injection or neurectomy of the motor branch of the ulnar nerve. 365 33

Injection of dilute phenol to peripheral nerves or motor block areas when there is spasticity, can, by damage to the nerves or motor areas, relieve the spastic condition, allow better nursing care, free the patient from the embarrassment of a contorted limb and may allow voluntary movement to take place.
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PMID:Phenol block in the treatment of spasticity. 367 46

Intractable lower extremity spasms after spinal cord injury is a significant source of morbidity. A case of refractory spasticity in paraplegia was successfully converted to flaccid paraplegia by intrathecal injection of phenol and glycerin in metrizamide. This chemical rhizolysis is simple and effective, and the presence of metrizamide allows both fluoroscopic guidance for accurate intrathecal phenol placement and good miscibility with cerebrospinal fluid. A brief comparative review of alternative therapeutic modalities is presented.
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PMID:Intrathecal phenol and glycerin in metrizamide for treatment of intractable spasms in paraplegia. Case report. 400 62

The effectiveness of radiofrequency (RF) cordotomy of segmental motoneurone pools of the lumbosacral cord in reducing spasticity of decerebrate cats is evaluated. The need for a new form of therapy for clinical spasticity is based upon the limitations of contemporary methods, including surgical and pharmacological techniques. In man, spasticity of spinal origin may be treated effectively by intrathecal administration of hyperbaric phenol solutions. The advantages and disadvantages are described. Difficulty in controlling the lesion is emphasized. Tension and EMG-length curves of the spastic triceps surae muscle in acute and chronic animals show that RF lesions (fixed amperage and duration) of the segmental motoneurone pools reduces myotatic reflex activity in accordance with the number of segments cordotomized. Clinical examination including cinematography and electromyography complement the physiological interpretation. RF lesions of the internuncial pool induce spontaneous EMG discharges. This finding is related to similar observations of EMG discharges and alterations in muscle tone after asphyxiation of the spinal cord.
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PMID:Radiofrequency cordotomy for the relief of spasticity in decerebrate cats. 528 93

Fifteen patients with bladder spasticity and pain of three different etiologies were referred to the pain clinic by urologic specialists. These patients were refractory to all prior methods of treatment, excluding major surgical procedures. In a prospective study started in 1976, these patients were treated with transsacral nerve blocks using 0.25% bupivacaine and, in most cases, subsequent 6% aqueous phenol at the right S-3 ventral foramen. If indicated, transsacral nerve blocks were performed at other levels, as described in the text. Of the patients studied 53% have had significant or complete relief of pain for an average of 26.5 months. The associated morbidity was negligible and there was no mortality. This is in contrast to the morbidity and mortality associated with some major surgical "curative" procedures. The technique is proposed as a successful and economical approach to treatment that can be managed on an outpatient basis.
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PMID:Treatment of bladder pain with transsacral nerve block. 617 61

The purpose of this paper is to outline a systematic approach to the care of adult patients with traumatic head injury. The orthopedic management of these individuals is divided in three phases. In the acute period after the initial trauma, musculoskeletal injuries should be diagnosed and treated. Delayed diagnoses of fractures and peripheral nerve injuries are common. Fracture care often differs from the care given to patients without head injuries because open reduction and internal fixation are more frequently indicated. The results of fracture treatment are compromised by spasticity and heterotopic ossification. The second phase is the subacute period during which neurologic recovery is occurring. This period may last up to 18 months. While neurologic recovery is proceeding, heterotopic ossification and spasticity with its resulting deformities are treated. Drugs, casting, and phenol blocks of peripheral nerves and motor points are used in the control of spasticity. Drugs and aggressive range-of-motion exercises aid in maintenance of joint motion when heterotopic ossification is present. When neurologic recovery has stabilized, the third phase begins. At this time, residual limb deformities may be surgically corrected and heterotopic bone may be excised.
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PMID:Orthopedic strategies in the management of the adult head-injured patient. 641 85

The motor points of spastic wrist and finger flexors were identified using a nerve stimulator. These motor points were injected percutaneously with either a 3% or 5% aqueous solution of phenol in 11 patients with brain injury. The effectiveness of the blocks was assessed by recording the resting angle of the wrist, active extension of the wrist, and passive extension of the wrist--first with the fingers flexed and then with the fingers extended. The blocks were repeated once in two patients and twice in one patient for return of muscle tone which interfered with hand function. Relaxation of muscle tone persisted for up to two months following the injections. The resting angle of the wrist improved a mean of 25 degrees. Active wrist extension improved an average of 30 degrees. The changes in wrist measurements represent the effects of different processes: 1) the neurolytic effect of the phenol block; 2) improvement in the neurologic status of the patient; and 3) regeneration of the motor end plate. This procedure is an effective method of temporarily controlling spasticity and allowing functional hand training while neurologic recovery is occurring.
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PMID:Percutaneous phenol blocks to motor points of spastic forearm muscles in head-injured adults. 671 48


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