Muscle spasticity [Muscle hypertonicity]
Muscle spasticity [Muscle hypertonicity]: Excerpt from Nursing: Interpreting Signs and Symptoms
Spasticity is a state of excessive muscle tone manifested by increased resistance to stretching and heightened reflexes. It's commonly detected by evaluating a muscle's response to passive movement; a spastic muscle offers more resistance when the passive movement is performed quickly. Caused by an upper motor neuron lesion, spasticity usually occurs in the arm and leg muscles. Long-term spasticity results in muscle fibrosis and contractures. (See How spasticity develops.)
History and physical examination
When you detect muscle spasticity, ask the patient about its onset, duration, and progression. What, if any, events precipitate its onset? Has he experienced other muscular changes or related symptoms? Does his medical history reveal an incidence of trauma or a degenerative or vascular disease?
Take the patient's vital signs, and perform a complete neurologic and musculoskeletal examination. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
Alert
During your examination, keep in mind that generalized spasticity and trismus in a patient with a recent skin puncture or laceration indicates tetanus. If you suspect this rare disorder, look for signs of respiratory distress. Provide ventilatory support, if necessary, and monitor the patient closely.
Medical causes
Amyotrophic lateral sclerosis (ALS).ALS commonly produces spasticity, spasms, coarse fasciculations, hyperactive deep tendon reflexes (DTRs), and a positive Babinski's sign. Earlier effects include progressive muscle weakness and flaccidity that typically begin in the hands and arms and eventually spread to the trunk, neck, larynx, pharynx, and legs; progressive respiratory muscle weakness leads to respiratory insufficiency. Other findings include dysphagia, dysarthria, excessive drooling, and depression.
Epidural hemorrhage.With epidural hemorrhage, bilateral limb spasticity is a late and ominous sign. Other findings include a momentary loss of consciousness after head trauma, followed by a lucid interval and then a rapid deterioration in the level of consciousness (LOC). The patient may also develop unilateral hemiparesis or hemiplegia; seizures; fixed, dilated pupils; a high fever; a decreased and bounding pulse; a widened pulse pressure; elevated blood pressure; an irregular respiratory pattern; and decerebrate posture. A positive Babinski's sign can be elicited.
Spinal cord injury.Muscle spasticity commonly results from cervical and high thoracic spinal cord injury, especially from incomplete lesions. Spastic paralysis in the affected limbs follows initial flaccid paralysis; typically, spasticity and muscle atrophy increase for up to 11⁄2 to 2 years after the injury, and then gradually regress to flaccidity. Associated signs and symptoms vary with the level of injury, but may include respiratory insufficiency or paralysis, sensory losses, bowel and bladder dysfunction, hyperactive DTRs, a positive Babinski's sign, sexual dysfunction, priapism, hypotension, anhidrosis, and bradycardia.
Stroke.Spastic paralysis may develop on the affected side following the acute stage of a stroke. Associated findings vary with the site and extent of vascular damage and may include dysarthria, aphasia, ataxia, apraxia, agnosia, ipsilateral paresthesia or sensory loss, vision disturbances, altered LOC, amnesia and poor judgment, personality changes, emotional lability, bowel and bladder dysfunction, headache, vomiting, and seizures.
Tetanus.Tetanus is a rare, life-threatening disease that produces varying degrees of muscle spasticity. In generalized tetanus—the most common form—early signs and symptoms include painful jaw and neck stiffness, trismus, headache, irritability, restlessness, a low-grade fever with chills, tachycardia, diaphoresis, and hyperactive DTRs. As the disease progresses, painful involuntary spasms may spread and cause boardlike abdominal rigidity, opisthotonos, and a characteristic grotesque grin known as risus sardonicus. Reflex spasms may occur in any muscle group with the slightest stimulus. Glottal, pharyngeal, or respiratory muscle involvement can cause death by asphyxia or cardiac failure.
Nursing considerations
▪ Prepare the patient for diagnostic tests, which may include electromyography, muscle biopsy, or intracranial or spinal magnetic resonance imaging or computed tomography.
▪ Administer pain medication and an antispasmodic, as ordered.
▪ Perform passive range-of-motion exercises, splinting, traction, and application of heat to help relieve spasms and prevent contractures.
▪ Maintain a calm, quiet environment to help relieve muscle spasms and prevent recurrence, and encourage bed rest.
▪ In cases of prolonged, uncontrollable muscle spasticity, as with spastic paralysis, prepare the patient for nerve blocks or surgical transection to provide permanent relief, as indicated.
Patient teaching
▪ Teach the patient to use assistive devices as needed.
▪ Help the patient to identify ways to maintain independence.
Pictures
![Muscle spasticity [Muscle hypertonicity] - 5615.1.png](/bookimages/16/5615.1.png)
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Gait, spastic [Hemiplegic gait] (Nursing: Interpreting Signs and Symptoms)
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