From the Guidelines
Treatment of MS hand contracture should prioritize a combination of physical therapy, stretching exercises, and medications to prevent permanent contractures and maintain hand function. When managing MS hand contractures, it's essential to consider the potential for spasticity and its impact on joint and muscle contractures, as seen in stroke patients 1. Key considerations include:
- Regular assessment and documentation of skin and joint condition to prevent skin breakdown and contractures
- Use of objective scales of risk, such as the Braden scale, to identify patients at high risk of skin injury
- Implementation of measures to minimize friction, pressure, and excessive moisture, and maintain adequate nutrition and hydration
- Daily stretching of the affected limbs to avoid contractures, with proper techniques taught to patients and families
- Potential use of resting hand splints, although their effectiveness is not well established, and may be combined with other treatments like botulinum toxin injection
- Consideration of surgical release of affected muscles as a reasonable option to treat pain and range-of-motion limitations in patients with substantial established contractures. In terms of specific medications, first-line options may include baclofen, tizanidine, or diazepam, with botulinum toxin injections considered for more severe contractures. Physical and occupational therapy play a crucial role in maintaining hand function and providing adaptive techniques and equipment for daily activities. Early and consistent treatment is vital to prevent permanent contractures and maintain hand function, as MS-related spasticity tends to worsen over time without proper management.
From the FDA Drug Label
Indications and Usage Baclofen tablets are useful for the alleviation of signs and symptoms of spasticity resulting from multiple sclerosis, particularly for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity. The answer to MS hand contracture is that baclofen may be useful in alleviating signs and symptoms of spasticity resulting from multiple sclerosis, which can include hand contracture, by relieving flexor spasms and muscular rigidity 2 3.
- Key points:
- Baclofen is used for the alleviation of signs and symptoms of spasticity resulting from multiple sclerosis.
- It is particularly useful for the relief of flexor spasms and concomitant pain, clonus, and muscular rigidity.
- Patients should have reversible spasticity so that baclofen treatment will aid in restoring residual function.
From the Research
MS Hand Contracture
- MS hand contracture can result from spasticity, a common symptom in multiple sclerosis patients 4, 5, 6, 7
- Intrinsic contracture of the hand may lead to a posture with hyperflexed metacarpophalangeal joints and hyperextended proximal interphalangeal joints, causing considerable disability 8
- Diagnosis is typically made via history and physical examination, with adjunctive imaging, rheumatologic testing, and electromyography used to determine the underlying cause or assess severity 8
Treatment Options
- Nonsurgical management may be appropriate in mild cases, consisting of occupational therapy, orthoses, and botulinum toxin injections 8, 4, 5, 6, 7
- Botulinum toxin injections have been shown to reduce muscle tone and improve passive function, and possibly improve active function, in patients with spasticity 5, 6, 7
- Surgical management options are diverse and dictated by the cause and severity of contracture 8
Efficacy of Botulinum Toxin
- There is level A evidence that injection of botulinum toxin-A into the bladder's detrusor muscle improves MS-related neurogenic detrusor overactivity and MS-related overactive bladder 6
- There is level B evidence for the utility of intramuscular botulinum toxin-A injections for spasticity of multiple sclerosis 6
- Emerging data suggests that intramuscular injection of botulinum toxin may help other symptoms of MS, such as focal tonic spasms, focal myokymia, spastic dysphagia, and double vision in internuclear ophthalmoplegia 6