Ultrasound guided alcohol neurolysis of musculocutaneous nerve to relieve elbow spasticity in hemiparetic stroke patients

Abstract

Proper management of elbow spasticity is important in stroke rehabilitation. We investigated the effect and safety of ultrasound guided alcohol neurolysis of the MC nerve for controlling elbow flexor spasticity in hemiparetic stroke patients. Ten hemiparetic stroke patients with severe elbow spasticity were recruited for this study. We identified the MC nerve using ultrasound and performed neurolysis with 35% ethyl alcohol. The severity of spasticity was assessed using the modified Ashworth scale (MAS) score and associated reaction (AR) of elbow flexor. During the 2 months follow-up period, both MAS score and AR were reduced in all 10 patients. Before treatment, the mean MAS score was 3.4 +/- 0.5, and this improved to 0.1 +/- 0.3 immediately post-neurolysis, 1.8 +/- 1.0 at one month and 1.9 +/- 0.8 at two months (p < 0.001). The mean change of AR of the affected elbow was significantly decreased, from 75.2 +/- 30.0 degrees before neurolysis to 24.8 +/- 21.3 degrees immediately post-neurolysis, 35.5 +/- 24.7 degrees at 1 month and 40.8 +/- 25.1 degrees at 2 months (p < 0.001). Ultrasound guided MC nerve block is an effective and safe procedure for relieving localized spasticity of the elbow flexor.