Upper Limb Spasticity

Upper limb spasticity refers to increased muscle tightness in the arm, wrist or hand caused by changes in the way the brain and nervous system control movement.

It is commonly seen following conditions such as stroke, brain injury or neurological disorders. Spasticity can lead to stiffness, abnormal positioning of the hand and difficulty with everyday activities.

The severity can vary, ranging from mild tightness to significant restriction of movement. In some cases, it may also cause discomfort or interfere with hygiene and care.

Treatment is focused on improving function, reducing discomfort and optimising hand position.

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Diagnosis is based on clinical assessment, including evaluation of muscle tone, movement and functional ability.

Assessment may involve:

• Examination of range of movement
• Evaluation of muscle tightness and control
• Assessment of how the hand is used in daily activities

A multidisciplinary approach may be used to guide treatment planning.

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Treatment is tailored to the individual and depends on the severity of spasticity and its impact on function.

Non-surgical treatment may include:

• Physiotherapy and stretching programmes
• Splinting to support positioning
• Botulinum toxin (Botox) injections to reduce muscle overactivity
• Occupational therapy to improve function

In selected cases, surgical treatment may be considered to improve positioning, release tight structures or restore balance in the hand.

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When surgical treatment is appropriate, procedures are tailored to the individual.

These may include:

• Tendon releases or lengthening
• Muscle releases
• Tendon transfers to improve function and balance

The aim is to improve positioning, ease of use and overall function of the hand.

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Recovery depends on the type of treatment performed and the underlying condition.

Recovery typically involves:

• Physiotherapy and rehabilitation
• Splinting where required
• Gradual improvement in movement and positioning

Treatment is often part of a longer-term management plan.

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As with any surgical procedure, there are potential risks, although these are uncommon.

Possible complications include:

• Infection (around 1%), usually treated with antibiotics
• Swelling or stiffness, which may take time to settle
• Scar sensitivity
• Nerve irritation or injury (rare)
• Ongoing pain or discomfort, which typically improves over time
• Recurrence of symptoms (uncommon)
• Residual symptoms, particularly if the condition was advanced before treatment
• Overcorrection or undercorrection of deformity
• Reduced strength in the treated muscles

Very rarely, a condition known as complex regional pain syndrome (CRPS) can occur, leading to prolonged pain and sensitivity.

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You should seek medical advice if stiffness or reduced movement in the arm or hand is affecting daily activities, comfort or care.

Assessment is important to understand the underlying cause and identify the most appropriate treatment options.

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