Upper Limb Spasticity

What Is Upper Limb Spasticity?

Upper limb spasticity is a condition that affects the way you move your arms. It makes your muscles stiff and flexed. Sometimes, your arms will twitch or move in a way you can’t control, called a spasm.

Spasticity happens after your body’s nervous system has been damaged, usually by a stroke, disease, or injury. It’s not life-threatening, but it can be painful and have a big effect on your daily life. Some tasks, like getting dressed or bathing, become hard.

But the outlook for treating upper limb spasticity is better than it has ever been. There are many treatments that can make your muscles more flexible and give you better control of your arm movements. If your symptoms improve, you may be able to reduce your treatment.

Causes

Your muscles move when they get electrical signals from the nerves that branch throughout your body. These signals come from your spinal cord and brain. When your brain or spinal cord is damaged, they don’t send those signals the right way. The uneven signaling causes your muscles to flex, stiffen, and twitch.

There are several things that can damage your brain or nervous system and lead to upper limb spasticity.

  • Strokes, which happen when an artery to your brain is blocked by a clot or it bursts. Without the blood and oxygen they need, brain cells can die, creating problems with some of the nerves in your body.
  • Diseases like multiple sclerosis and cerebral palsy, which destroy the nervous system
  • Injuries

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Symptoms

You may not have any symptoms of upper limb spasticity until weeks, months, or even years after you have a stroke or brain injury. The condition can cause:

  • Stiff arm muscles
  • Twitches or movements that you can’t control
  • Trouble using or moving your arms
  • Tightness in the muscles in your elbows, wrists, or fingers
  • Arms that get stuck in uncomfortable positions, such as pressed against your side.
  • Rotated shoulders
  • Bent elbows or wrists
  • Hands clenched into fists
  • Difficulty or pain when you move or straighten your arm, elbows, wrists, or fingers

Without treatment, your muscles can seem frozen in these positions. Spasms and stiffness can make it very hard to do normal tasks like dressing yourself.

If you notice muscle tightness, spasms, or stiff limbs at any time after you’ve had a stroke or brain injury, you should tell your doctor right away.

Getting a Diagnosis

You’ll need to see a neurologist, a specialist who treats problems with the brain and nervous system.

She’ll give you a physical exam and test your muscle movement to see how well you can control your arms, elbows, wrists, and hands. She’ll flex your joints to see how limber they are. She may ask you to move your arms on your own to see how much control you have.

The doctor will also ask you questions about your symptoms, like:

  • Which muscles are having spasms?
  • When did they start?
  • How often do you have them?
  • Does anything make your muscles feel better or worse?
  • Are you having any pain or stiffness?
  • Do you have any trouble doing daily tasks or taking care of yourself? What’s hard for you?

Your doctor may also use a test called electromyography, or EMG, to see how well your arm muscles and nerves are working. For this test, you’ll sit or lie down, and a technician will put electrodes on your arms. The electrodes have small needles that go into your muscles, and they’re attached by wires to a machine that can measure the electricity in your muscles and nerves. Your doctor will ask you to slowly flex and relax your arms so the machine can record the activity. She may also inject a drug to briefly numb the area where you have spasms to see if they still happen when you can’t move your muscles. The test can take 30 minutes to an hour.

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Questions for Your Doctor

You’ll want to find out as much as you can about your condition so you can learn how to control it and feel better. You might want to ask:

  • What caused my spasticity?
  • What kinds of treatments are there?
  • Which ones would be best for me?
  • How will the medicines make me feel?
  • Do I need physical therapy?
  • How long will I need treatment?
  • What can I do to make my arms less stiff?

Treatment

The goal of treatments for upper limb spasticity is to keep your muscles from becoming too stiff and give you more freedom to move your arms. It’s important to get therapy so you can keep moving your muscles and stop them from getting stiffer and more painful.

Your doctor will recommend a treatment based on how healthy you are and the symptoms you have. There are several options that may work for you.

  • Exercises, like stretches, may help your joints and muscles become more flexible. A physical therapist can teach them to you.
  • Braces or splints hold your muscles and joints in the right position and keep them from getting too tight.
  • OnabotulinumtoxinA (Botox) and abobotulinumtoxinA (Dysport), used for the treatment of upper and lower limb spasticity, can relax muscles and ease spasms. Your doctor can give you a shot of it directly into your muscles. Botox and Dysport have some potentially serious side effects such as breathing and swallowing issues, so make sure to discuss them with your physician.
  • Drugs like clonazepam (Klonopin), diazepam (Valium), and tizanidine (Zanaflex) also make your muscles more relaxed.
  • Intrathecal baclofen therapy (ITB). Baclofen is a drug that corrects the way your nerves send signals to your muscles. ITB delivers it through a pump to an area of the spinal cord, called the intrathecal space, to prevent spasms.
  • Nerve block injections, shots of drugs that numb the nerves that cause muscles to twitch, may stop spasms when other medicines don’t work.
  • Surgery to cut connections between nerves or tendons and muscles that spasm. Your doctor may recommend this if other treatments don’t work.

If your condition gets better, you may be able to reduce your treatment. It’s important to stick to your therapy plan and tell your doctor about any changes in how you feel.

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Taking Care of Yourself

Along with treatment, there are things you can do to keep your muscles and joints as flexible as possible.

  • Stay as active as you can. Exercise will loosen your muscles and increase your flexibility. Swimming and strength-building activities may especially help. Play games or sports, or try to do normal household tasks to stay active and move stiff limbs.
  • Get enough sleep. If you’re tired, your symptoms may get worse.
  • Find ways to relax. Stress can make spasticity worse, so find low-key activities that you enjoy. Try reading, taking a walk, or meditation.

What to Expect

Without treatment, upper limb spasticity can make your muscles stiffer and more painful over time. But new treatments can give you better control of your arms and help you live an active life. Your physical therapist or occupational therapist can help you find ways to increase your flexibility or find new, easier ways to do tasks.

Getting Support

Find helpful information and support from organizations like the American Stroke Association (ASA). You can find stroke support groups in your area or to join a group online.

Call the ASA at 888-478-7653 to be connected to a trained volunteer who can provide support or offer advice.

WebMD Medical Reference Reviewed by Neil Lava, MD on March 06, 2019

Sources

SOURCES:

American Stroke Association: “Spasticity.”

American Stroke Association: “What Is Stroke?”

Wake Forest University Baptist Medical Center: “New Hope for the Treatment of Upper Limb Spasticity.”

American Association of Family Physicians: “Upper Limb Spasticity.”

National Institute of Neurological Disorders and Stroke: “Spasticity Information Page.”

University of Miami Miller School of Medicine: “Rehabilitation of Moderate to Severe TBI: Movement Disorders, Spasticity and Contractures.”

University of Vermont Fletcher Allen Health Care: “Spasticity.”

University of Vermont Fletcher Allen Health Care: “Spasticity Treatment.”

Central Peninsula Hospital (Arkansas): “Caring for Muscle Spasticity or Spasms.”

American Stroke Association: “Finding Support: You Are Not Alone.”

Business Wire. “Ipsen announces FDA approval of Dysport® (abobotulinumtoxinA) for injection in the treatment of upper limb spasticity in adults in the United States.”

 

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