Among the myriad of side effects that result from a stroke are mobility issues, ranging from flexed elbows and wrists, along with clenched fists.

How ULS happens

Among the signs of upper limb spasticity (ULS), which can negatively affect stroke survivors, are arms that become tight and are forced up against the body, as well as uncontrollable muscle movements or spasms that occur at inopportune moments. The muscles in the elbow, wrist and fingers grow uncomfortably tight and stiff. In adults with upper limb spasticity, there is an imbalance of signals from the brain to the muscles, which causes stiffness and spasms. This can lead to abnormal arm or hand positions, uncomfortable movement and pain. Treatment options can help with muscle stiffness, but have not been shown to directly improve daily tasks.


A recent Harris Poll survey conducted on behalf of Merz Neurosciences found that more than 8 in 10 of people surveyed who are familiar with upper limb spasticity (84 percent) say that it negatively affects someone’s quality of life a moderate amount or a great deal. And of the respondents who have suffered a stroke, or know someone who has, the ability to perform daily tasks—doing chores, driving, tending to personal hygiene, dressing themselves, caring for family, desiring to participate in social or recreational activities, feeding themselves—have all been impacted.

“...more than 8 in 10 of people surveyed who are familiar with upper limb spasticity (84 percent) say that it negatively affects someone’s quality of life a moderate amount or a great deal."

“It can affect something as simple as hand hygiene, because it is difficult for them to open their affected hand. Hands can develop an odor, and it can be difficult to cut their nails,” says Dr. Heather Walker, the program director of Neuroscience Services at the HealthSouth Rehabilitation Hospital in Charleston, S.C. “You can get skin breakdown, rashes under arms and over time, if the spasticity is not addressed, you can suffer permanent changes in the muscle.”

Flagging the symptoms

The American Association of Neurological Surgeons lists several treatments for adult ULS, including physical and occupational therapy, oral medications, botulinum toxins and surgery. It’s important that patients talk with their doctor about treatment options, treatment goals and potential side effects. Botulinum toxin injections are a popular choice for patients and doctors” says Walker. The injections are typically given every three to four months by a professional. Treatments, including botulinum toxins, may not necessarily improve the quality of life issues caused by ULS.

Because the ULS symptoms don’t always show up right away, and onset could be months or even a year after stroke, Walker adds that caregivers should take note of any issues with range of motion—and seek evaluation from specialists if a problem arises. “We can treat it if it is early on, but it becomes more difficult once we miss the boat and the patient develops muscle changes.”

Fighting back

“In recent years, three botulinum toxins have received FDA approval to treat muscles associated with adult upper limb,” explains Dr. David M. Simpson, a professor of neurology at The Icahn School of Medicine at Mount Sinai’s Department of Neurology. “U.S. physicians now have greater flexibility in selecting a treatment for ULS that might better meet the needs of their individual patients. Of course, any treatment decision needs to be weighed against the potential risks and side effects.”