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Injections to Reduce Arm Spasticity After a Stroke

Is your spasticity limited to only one arm? If so, nerve block injections may be the best option for you. That’s because they’re effective and have fewer side effects than oral medications. Two main types of injections are commonly used: botulinum toxin and phenol.

Botulinum toxin (Botox or Myobloc) is a neurotoxin that works by blocking chemicals that make muscles tight. These injections usually improve muscle stiffness within two to four weeks. You may need more than one shot, although too many injections may be counterproductive, says Joel Stein, MD, professor and chief of the division of rehabilitation medicine at Weill Cornell Medical College in New York City.

Ross Bogey, DO, assistant professor of physical medicine and rehabilitation at the Rehabilitation Institute of Chicago, says that botulinum toxin may indirectly help with stroke rehab, especially for patients who can’t undergo therapy because of spasticity in their wrist and hands. "We often use Botox to reduce spasticity so patients can participate in therapy that leads to ... recovery," he says.

Botulinum toxin is approved by the FDA for use in upper extremity spasticity. The most common side effects of botulinum toxin are:

  • soreness at the injection site or affecting your whole body
  • weakness in muscles that have been injected
  • trouble swallowing
  • a red rash 

Baclofen can be given as an injection within the space surrounding the spinal cord also known as intrathecal injections. However, this this requires surgical implantation of a pump that delivers the drug to the spinal cord. Side effects may include:

  • Drowsiness
  • Nausea or vomiting
  • Headache or dizziness
  • Loose muscles
  • A problem with the catheter delivering the drug 

Phenol is an alcohol injection that acts more quickly and may last longer. It provides relief from spasticity by eliminating certain nerve pathways.

The most common side effects of phenol are:

  • pain during injection
  • burning or tingling sensation at the injection site
  • swelling in the injection area 

When Spasticity Persists After a Stroke

Surgery is a last resort in severe cases.

"If someone has significant ongoing pain despite trying multiple injections, oral medications, or intrathecal medications, they might need to consider surgery to the tendons, for instance, to improve tone in that limb," Gottesman says. The same is true, she tells WebMD, for a patient who can’t tolerate any of the medications.

Surgery might be used in cases where someone has developed a permanent shortening of the tendon and treating the spasticity alone won't help, Bogey says. "You have to lengthen the tendons to get them back into a functional position," he says. In other cases, surgery may be used to cut and transfer tendons or to sever the nerve muscle pathway.

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