Alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle to treat ankle spasticity in patients with hemiplegic stroke.
OBJECTIVE
To evaluate the effectiveness of alcohol neurolysis of tibial nerve motor branches to the gastrocnemius muscle for the treatment of ankle plantarflexor spasticity in patients with hemiplegic stroke.


METHODS
Case series.


METHODS
Inpatient and outpatient clinics in the rehabilitation department of a university hospital.


METHODS
Twenty-two patients with hemiplegic stroke (mean age, 48y).


METHODS
Motor branch block (MBB) of the tibial nerve to the gastrocnemius muscle with 50% ethyl alcohol in cases of spastic ankle.


METHODS
The severity of spasticity was assessed using the Modified Ashworth Scale (MAS) score of ankle plantarflexor, clonus score of the ankle, and the passive range of motion (PROM) of ankle dorsiflexion.


RESULTS
The MAS score was reduced in 17 (77%) of 22 patients during the 6-month follow-up, and spasticity reappeared at the level of the pre-MBB state in 5 patients (23%). The mean values of all parameters were significantly improved. The changes of mean values from the pre-MBB to the 6-month post-MBB stage were as follows: MAS score, 3.3+/-0.7 versus 1.7+/-1.1; clonus score, 1.6+/-0.7 versus 0.4+/-0.8; and PROM, 17.1 degrees +/-13.0 degrees versus 28.6 degrees +/-4.7 degrees. No serious complications were observed during the 6-month follow-up period.


CONCLUSIONS
MBB of the tibial nerve to the gastrocnemius muscle is an effective and safe procedure for relieving localized spasticity of the ankle plantarflexors.
Jang
Sung Ho
SH
Department of Physical Medicine & Rehabilitation, Yeungnam University School of Medicine, Taegu, South Korea. strokerehab@hanmail.net
Ahn
Sang Ho
SH
Park
Sung Min
SM
Kim
Seong Ho
SH
Lee
Kang Hee
KH
Lee
Zee Ihn
ZI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D018482:Muscle, Skeletal / Q000294:innervation; D009407:Nerve Block / Q000379:methods*; D020521:Stroke / Q000150:complications*; D013979:Tibial Nerve
D000431:Ethanol