What is Upper Limb Spasticity (ULS)?
If you or someone you love lives with upper limb spasticity, you are not alone. Spasticity is a debilitating condition impacting approximately 1 million Americans1, many of whom suffer from spasticity in the upper limbs following a stroke. Upper limb spasticity results in uncomfortable muscle stiffness and muscle tightness in the elbow, wrist and fingers. People living with upper limb spasticity may have an arm pinned against their chest, a flexed elbow or wrist that can't be straightened without discomfort or force, or a clenched hand in a tight, balled up fist.
Sadly, in spite of how many people it affects, upper limb spasticity often goes undiagnosed, leaving people to suffer needlessly when there are medical specialists — such as neurologists and physiatrists — who can help them learn about available treatment options. Part of the reason for the low awareness and under-diagnosis is that upper limb spasticity may develop weeks, months or even years after the person's original injury — often after the person has left the hospital or is no longer being treated by medical specialists familiar with the onset of the condition.
Upper limb spasticity is common after a stroke (according to a survey of 504 American stroke survivors or primary caregivers for a stroke survivor, 58% report experiencing spasticity)2, and may also occur sometime after a spinal cord or traumatic brain injury or in adults with multiple sclerosis or a history of cerebral palsy.
How does upper limb spasticity develop? Upper limb spasticity results from damage to parts of the central nervous system that control voluntary movements. The damage causes the brain to over-communicate with the muscles in the elbow, wrist or fingers, constantly telling them to contract or tighten. It's these muscle spasms that lead to the debilitating muscle stiffness or tightness experienced by those who suffer from upper limb spasticity.
While upper limb spasticity is not life-threatening, its effects can be significant for both those living with the condition as well as family and friends who often are needed to help care for their loved one. Upper limb spasticity impacts the way a person performs simple tasks - they simply cannot do things the way they were accustomed to doing them before. This leads to increased dependence on family and friends, who sometimes can only watch helplessly as their loved one struggles.
If you think that you or someone you love may have upper limb spasticity, then you should speak to a doctor or rehabilitation therapist right away, even if you have been struggling with the condition for many years. The good news is that in many cases, treatment options are available. Once you speak with your doctor, you may be referred to a neurologist or physiatrist, or other specialists who can help diagnose and treat upper limb spasticity.
Learn more about upper limb spasticity in stroke
Stroke is a serious problem in the United States. Each year, approximately 795,000 strokes occur and about 144,000 people die as a result.3 A stroke occurs when a blood clot blocks the flow of blood to the brain. When blood flow is interrupted, brain cells die, causing brain damage. When this happens, the abilities controlled by the damaged part of the brain, such as speech, memory and movement, are affected.
Paralysis and spasticity are effects often experienced following a stroke. While both of these conditions affect movement, they are not the same. When experiencing paralysis, the brain is unable to communicate with the affected muscles. With upper limb spasticity following stroke, the nerves leading to the muscles cannot regulate themselves (due to broken communication with the brain, that helps to provide normal muscle tone), and permanently "over-fire" these commands to tighten and contract.
When a stroke first happens, the medical care is focused on saving the person's life and preventing another stroke. Fortunately, advances in medical care have led to an increase in stroke survival rates.4 However, many stroke survivors may have upper limb spasticity as an after-effect. Since upper limb spasticity may not set in until weeks, months, or even years after a stroke, it often is not addressed during the initial stages of stroke recovery. This means that upper limb spasticity often goes undiagnosed and under-treated in stroke survivors, even though according to a 2006 survey conducted by National Stroke Association among stroke survivors and caregivers, it was found that 58 percent of the people surveyed experienced spasticity with only 51 percent of those patients receiving treatment for their condition.5
If you or someone you love has had a stroke and is experiencing upper limb spasticity symptoms like muscle stiffness or muscle tightness in the arm or hand, speak to your doctor right away so that you can be referred to a specialist, such as a neurologist or physiatrist, for diagnosis and treatment. Or click here if you need help to find a doctor who specializes in the condition. Learn more about treatment of upper limb spasticity. Get more information on strokes by visiting National Stroke Association website.
Find out how upper limb spasticity impacts people with the condition and their loved ones
"Open Arms: Raising Awareness for Upper Limb Spasticity" Educational Campaign Advocacy Partners. Sponsors of the Open Arms educational campaign do not endorse any specific treatment for upper limb spasticity
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BOTOX® is a prescription medicine that is injected into muscles and used to treat increased muscle stiffness in elbow, wrist, and finger muscles with upper limb spasticity in people 18 years and older.
It is not known whether BOTOX® is safe or effective for other types of muscle spasms.
BOTOX® may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX®:
- Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months.
- Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice (dysphonia), trouble saying words clearly (dysarthria), loss of bladder control, trouble breathing, trouble swallowing.
There has not been a confirmed serious case of spread of toxin effect away from the injection site when BOTOX® has been used at the recommended dose to treat severe underarm sweating, blepharospasm, or strabismus.
The dose of BOTOX® is not the same as, or comparable to, another botulinum toxin product.
Serious and or immediate allergic reactions have been reported. These reactions include itchy rash, swelling, and shortness of breath. Tell your doctor or get medical help right away if you experience any such symptoms, further injection of BOTOX® should be discontinued.
Do not take BOTOX® if you: are allergic to any of the ingredients in BOTOX® (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® or Dysport®; have a skin infection at the planned injection site.
Tell your doctor about all your muscle or nerve conditions such as amyotrophic lateral sclerosis [ALS or Lou Gehrig's disease], myasthenia gravis or Lambert-Eaton syndrome as you may be at increased risk of serious side effects including severe dysphagia (difficulty swallowing) and respiratory compromise (difficulty breathing) from typical doses of BOTOX®.
Tell your doctor about all your medical conditions, including if you have: plans to have surgery; had surgery on your face; weakness of forehead muscles, such as trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; are pregnant or plan to become pregnant (It is not known if BOTOX® can harm your unborn baby); are breast-feeding or plan to breastfeed (It is not known if BOTOX® passes into breast milk).
Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins and herbal products.
BOTOX® may cause loss of strength or general muscle weakness, or vision problems. If this happens, do not drive a car, operate machinery, or do other dangerous activities.
Other side effects of BOTOX® include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes.
For more information refer to the Medication Guide or talk with your doctor.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Please see full Product Information, including Medication Guide for BOTOX®.
- Allergan data on file; Global Literature & Information Services
- National Stroke Association. New Survey Emphasizes Need for More, Better Care After Stroke. Available at http://www.stroke.org/site/DocServer/NSA_Stroke_Perceptions_Survey_Press_Release__final_.pdf?docID=1943 Accessed 4/1/10
- National Stroke Association. Stroke 101 Fact Sheet. Available at http://www.stroke.org/site/DocServer/STROKE_101_Fact_Sheet.pdf?docID=4541 Accessed 4/1/10
- Howard G, Howard VJ, Katholi C, Oli MK, Huston S, .Decline in US Stroke Mortality: An Analysis of Temporal Patterns by Sex, Race, and Geographic Region. Stroke. 2001;32:2213 http://stroke.ahajournals.org/cgi/content/full/32/10/2213
- National Stroke Association. New Survey Emphasizes Need for More, Better Care After Stroke. Available at http://www.stroke.org/site/DocServer/NSA_Stroke_Perceptions_Survey_Press_Release__final_.pdf?docID=1943 Accessed 4/1/10