Ask the Doctors

Ask Dr. Lea

      • Why do I have stiffness of my arm and leg on one side of my body after my stroke? When I had the stroke my arm and leg were weak and unable to move.
        This stiffness that you have in your arm and/or leg is called “spasticity”. Spasticity occurs when, as a result of a stroke, the brain loses its ability to turn off the signal to muscles to tell them to move. As a result those muscles are constantly being stimulated by the brain to be active. It occurs most often when you are attempting to use the muscles in question such as reaching for something standing up or attempting to walk.  It can be a frustrating situation because the muscles won’t do what your brain is telling them to do. There are very common patterns and body positions as a result of spasticity.  Some are illustrated in the picture here.  Note the bending of the patient’s elbow wrist and the clenching of his fingers.  Also note the bending of his ankle inward and downward. Spasticity can develop at any time after a stroke even when a victim of stroke initially has no movement whatsoever in their limbs.  It (spasticity) most commonly develops within the first year after a stroke, but can occur even later usually within 2 years.
      • Can the stiffness in my arms and legs go away all by itself?
        It is not uncommon for spasticity to be temporary.  However, the approach to treatment is to manage spasticity whenever it occurs.  Most treatments are as temporary as the spasticity can be, so they can be implemented for short periods of time, and do not have permanent effects.  In general, if spasticity has been present 6 months to a year after a stroke,  it will likely remain. It is always best to treat spasticity when it occurs in order to reduce the damage (pain, joint contracture, muscle contracture, skin breakdown) it can cause to the body of the stroke victim.
      • What types of medications can help me reduce the stiffness?
        There are several oral, injected and medical device delivered medications that can be used to combat spasticity. These medications can be used alone or in combination in some cases. A spasticity specialist can give excellent advice about what medications are beneficial for your type of spasticity and whether or not combinations of medications and interventions should be used.
      • Are there any surgical procedures that can help me with my stiffness?
        Surgical procedures that are common in the face of spasticity include tendon lengthening and removal of fused bone within joints. Implantation of a medication infusing pump is also a common procedure in appropriate patient cases.
      • What are the long-term effects of this stiffness if I decide to do nothing about it?
        Untreated spasticity in its worst form can lead to atrophy or hypertrophy of muscle, muscle fibrosis and loss of elasticity as well as shortening of muscle tendons and joint range of motion causing contracture of joints. Complete loss of joint movement through joint fusion can also occur.

Ask Dr. Raghaven

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