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Spasticity is a state of excessive muscle tone manifested by increased resistance to stretching and heightened reflexes. Also known as muscle hypertonicity, 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.)
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.
If 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 assessment. Test reflexes and evaluate motor and sensory function in all limbs. Evaluate muscles for wasting and contractures.
Amyotrophic lateral sclerosis (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.
Bilateral limb spasticity is a late and ominous sign of epidural hemorrhage. 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 (LOC). 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.
Muscle spasticity, hyperreflexia, and contractures may eventually develop in patients with multiple sclerosis; 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.
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 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 DTRs, positive Babinski’s sign, sexual dysfunction, priapism, hypotension, anhidrosis, and bradycardia.
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 LOC, amnesia and poor judgment, personality changes, emotional lability, bowel and bladder dysfunction, headache, vomiting, and seizures.
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.
In children, muscle spasticity may be a sign of cerebral palsy.
Teach the patient how to use assistive devices to perform activities of daily living. Encourage him to be as independent as possible. Also encourage him to verbalize his feelings about changes in his body image and issues of control.
Read excerpts from these other book chapters related to Muscular Hypertrophy:
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1 
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