From the Guidelines
Attending a limbs spasticity clinic as a plastic surgery resident is crucial for understanding the intersection of neuromuscular conditions and reconstructive procedures, and you should prioritize reviewing spasticity pathophysiology and common treatments, including botulinum toxin injections and surgical interventions, as recommended by the American Heart Association/American Stroke Association guidelines 1. As a plastic surgery resident, it is essential to understand the management of spasticity in limbs, which can be achieved by reviewing the pathophysiology of spasticity, focusing on how upper motor neuron lesions cause muscle hypertonicity through disrupted inhibitory pathways. Familiarize yourself with assessment tools like the Modified Ashworth Scale and common treatments, including:
- Botulinum toxin injections (Botox 50-400 units depending on muscle groups, effects lasting 3-6 months) 1
- Oral medications (baclofen 5-25mg TID, tizanidine 2-8mg TID)
- Surgical interventions, such as tendon repositioning to promote more functional joint mechanics, which may be considered in select patients (Level C) 1 During the clinic, observe how the multidisciplinary team evaluates patients, noting functional goals and treatment decision-making. Pay particular attention to cases where spasticity management precedes reconstructive procedures, as reducing muscle tone often improves surgical outcomes for contractures or deformities. Consider how your plastic surgery skills might complement spasticity management through:
- Tendon transfers
- Contracture releases
- Functional repositioning procedures This experience will enhance your understanding of comprehensive patient care and expand your ability to collaborate effectively with rehabilitation specialists, as emphasized by the guidelines for adult stroke rehabilitation and recovery from the American Heart Association/American Stroke Association 1.
From the Research
Limbs Spasticity Clinic Overview
As a plastic surgery resident attending a limbs spasticity clinic, it is essential to understand the management and treatment options for spasticity.
- Spasticity is a common feature of chronic neurological conditions, and if poorly managed, it can result in pain, contractures, and pressure sores, impacting function 2.
- A multidisciplinary management strategy is crucial, including education, physical management programs, and medication such as baclofen, tizanidine, and botulinum toxin 2, 3.
Treatment Options for Spasticity
Various treatment options are available for managing spasticity, including:
- Medications like baclofen, tizanidine, and gabapentin 2, 3
- Botulinum toxin therapy, which can be used as adjunctive therapy or alone to provide localized decrease in symptoms of spasticity and pain 4, 5, 6
- Intrathecal baclofen or phenol for predominant lower limb spasticity 2
- Physical therapies, such as exercise and stretching, to improve mobility and reduce muscle tone 6
Patient-Centered Care
Patient reports on spasticity are essential and should be part of clinical evaluation and practice 4.
- Patients with spasticity often experience pain, immobility, and risk of falls, highlighting the need for effective management strategies 4.
- Bedside care strategies, such as alternative therapies and medications, can be used to better manage spasticity and improve patient outcomes 4.
Efficacy and Safety of Botulinum Toxin
Botulinum toxin type A has been shown to be an effective therapeutic option for spasticity caused by spinal cord injury, with improved modified Ashworth scale scores and disability assessment scale scores 6.
- However, botulinum toxin type A may cause adverse effects such as bronchitis and elevated blood pressure, while baclofen may cause asthenia and sleepiness 6.