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Spasticity

Muscle stiffness; Hypertonia

 

Spasticity is stiff or rigid muscles. It may also be called unusual tightness or increased muscle tone. Reflexes (for example, a knee-jerk reflex) are stronger or exaggerated. The condition can interfere with walking, movement, or speech.

Considerations

 

Spasticity is usually caused by damage to the part of the brain that is involved in movements under your control. It may also occur from damage to the nerves that go from the brain to the spinal cord.

Symptoms of spasticity include:

  • Abnormal posture
  • Carrying the shoulder, arm, wrist, and finger at an abnormal angle because of muscle tightness
  • Exaggerated deep tendon reflexes (the knee-jerk or other reflexes)
  • Repetitive jerky motions (clonus), especially when you are touched or moved
  • Scissoring (crossing of the legs as the tips of scissors would close)

Spasticity may also affect speech. Severe, long-term spasticity may lead to contracture of muscles. This can reduce range of motion or leave the joints bent.

 

Causes

 

Spasticity may be caused by any of the following:

  • Adrenoleukodystrophy
  • Brain damage caused by lack of oxygen, as can occur in near drowning or near suffocation
  • Cerebral palsy
  • Head injury
  • Multiple sclerosis
  • Neurodegenerative illness -- illnesses that damage the brain and nervous system over time
  • Phenylketonuria
  • Spinal cord injury
  • Stroke

This list does not include all conditions that can cause spasticity.

 

Home Care

 

Exercise, including muscle stretching, can help make symptoms less severe. Physical therapy is also helpful.

 

When to Contact a Medical Professional

 

Contact your health care provider if:

  • The spasticity gets worse
  • You notice deformity of the affected areas

 

What to Expect at Your Office Visit

 

Your doctor will perform a physical exam and ask about your symptoms, including:

  • When was it first noticed?
  • How long has it lasted?
  • Is it always present?
  • How severe is it?
  • What muscles are affected?
  • What makes it better?
  • What makes it worse?
  • What other symptoms are present?

After determining the cause of your spasticity, the doctor may refer you to a physical therapist. Physical therapy involves different exercises, including muscle stretching and strengthening exercises. Physical therapy exercises can be taught to parents who can then help their child do them at home.

Other treatments may include:

  • Medicines may be prescribed to treat spasticity. These need to be taken as instructed.
  • Botulinum toxin can be injected into the spastic muscles.
  • In rare cases, a pump is used to directly deliver medicine into the spinal fluid and nervous system.
  • Sometimes surgery is needed to release the tendon or to cut the nerve-muscle pathway.

 

 

References

Dobkin BH. Principles and practices of neurological rehabilitation. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 48.

Griggs RC, Jozefowicz RF, Aminoff MJ. Approach to the patient with neurologic disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 396.

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      Review Date: 2/3/2015

      Reviewed By: Amit M. Shelat, DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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