Muscle spasticity [Muscle hypertonicity]
Muscle spasticity [Muscle hypertonicity]: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
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
Once you detect spasticity, ask the patient about its onset, duration, and progression. What, if any, events precipitate onset? Has he experienced other muscular changes or related symptoms? Does his medical history reveal any incidence of trauma or degenerative or vascular disease?
Take the patient’s vital signs, and perform a complete neurologic examination. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
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
This disorder commonly produces spasticity, spasms, coarse fasciculations, hyperactive deep tendon reflexes, 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 this disorder, 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 level of consciousness. The patient may also develop unilateral hemiparesis or hemiplegia; seizures; fixed, dilated pupils; high fever; decreased and bounding pulse; widened pulse pressure; elevated blood pressure; irregular respiratory pattern; and decerebrate posture. A positive Babinski’s sign can be elicited.
Multiple sclerosis
Muscle spasticity, hyperreflexia, and contractures may eventually develop; earlier muscle changes include progressive weakness and atrophy. Associated signs and symptoms typically wax and wane and may include diplopia, blurring or loss of vision, nystagmus, sensory loss or paresthesia, dysarthria, dysphagia, incoordination, ataxic gait, intention tremors, emotional lability, impotence, and urinary dysfunction.
Spinal cord injury
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 1¼ to 2 years after the injury, 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 deep tendon reflexes, 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, visual disturbance, altered level of consciousness, amnesia and poor judgment, personality changes, emotional lability, bowel and bladder dysfunction, headache, vomiting, and seizures.
Tetanus
This rare, life-threatening disease produces varying degrees of spasticity. In generalized tetanus, the most common form, early signs and symptoms include painful jaw and neck stiffness, trismus, headache, irritability, restlessness, low-grade fever with chills, tachycardia, diaphoresis, and hyperactive deep tendon reflexes. 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.
Special 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. Passive range-of-motion exercises, splinting, traction, and application of heat may help relieve spasms and prevent contractures. Maintain a calm, quiet environment to help relieve spasms and prevent recurrence, and encourage bed rest. In cases of prolonged, uncontrollable spasticity, as with spastic paralysis, nerve blocks or surgical transection may be necessary for permanent relief.
Pediatric pointers
In children, muscle spasticity may be a sign of cerebral palsy.
Pictures
![Muscle spasticity [Muscle hypertonicity] - 2644.png](/bookimages/8/2644.png)
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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