Severe Muscle Contractures

    
      Re: Severe Muscle Contractures
    


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Posted by CCF Neuro MD on July 06, 1997 at 21:45:18:

In Reply to: Severe Muscle Contractures posted by Shirley on June 28, 1997 at 14:28:50:
  My mom had a stroke in May of 1996 and was recovering nicely, having
  regained most of the use of her left arm and was walking again when she
  had a fall causing a compression fracture in the lumbar spine in Feb 1997.
  Three weeks later, she had recovered significantly and had a very rigorous
  physical therapy session which caused severe muscle spasms in her back. At
  that point, her left arm began contracting, much worse than it had right
  after her stroke, and the doctors say that she could have had another
  stroke, or her stroke could have deepened for unknown reasons.
  We've been working on rehabing her left arm now for the last 3 months,
  doing the stretching exercises that were recommended to try and release
  the contractures, but we're not making much progress. She continues to
  have severe pain in her left shoulder, elbow, and hand, and must use
  narcotic medications for relief.  She is currently on vicodin, but we
  don't like to have her on it round the clock because it impairs her
  cognitive functions and makes her muscles weak, so she is still
  experiencing significant pain.
  Is there any way to deal with these muscle contractures in addition to the
  stretching exercises, which only seem to worsen the pain and prevent the
  contractures from worsening, but don't seem to be able to release the
  muscles?  How do you rehabilitate a contracted arm that doesn't seem to
  respond to traditional methods? We've tried muscle relaxants as well as
  morphine, both of which cause so much muscle weakness and cognitive
  deficiency that it's almost impossible to care for her adequately, so we
  don't want to use those types of medications if there's an alternative.
  Any suggestions would be greatly appreciated.
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Hello, Shirley,
  Muscle contracture is a common long term complication of stroke.  It is usually the result of disruption of balance between extension and flexion muscles.  The management of this condition is quite difficult. the major drawback of muscle relaxants, as you already noted, is causing muscle weakness.  Physical therapy is the way to go.  Although as a neurologist, I do not know how to do the specific exercise program for your mother's muscle condition, I would like to refer you to the PT specialist at the PT/Rehab department at the Cleveland Clinic Foundation.  Given your mother's medical history, in my opinion, she can benefit the most from a full evaluation from neurology, rehabilitation, and PT/OT.  At the Cleveland Clinic Foundation, we have one of the best stroke service in the country, led be Dr. Anthony Furlan.  In addition, there are several PT/Rehab specialists working very closely with us, who are specialized in post stroke rehab.  We will be happy to see you and your mother here soon.  Please call toll free [phone] or [phone] ext. 45559 for an appointment.
  This information is provided for general medical education purposes only.  Please consult your primary physician for the diagnosis and treatment of your specific medical condition.