Objective: To evaluate efficacy and patients’ perception of the ultrasound-guided selective diagnostic nerve block (DNB) of the motor branch for brachialis muscle compared with the standard DNB of the musculocutaneous nerve in patients with upper limb spasticity (ULS) and flexed elbow pattern.

Background: Upper limb spasticity is a common motor condition following several neurological disorders and flexed elbow pattern is one of the most reported.  Biceps brachii is the most treated muscle for elbow spasticity but recent evidence questioned its role in favor of brachialis muscle. US-guided selective DNB could be useful to investigate the differential role of these two muscles in patients with elbow spasticity.

Method: Clinical records of 24 patients who underwent a standard US-guided DNB of musculocutaneous nerve (N=12) or a selective US-guided DNB of the motor branch for brachialis (N=12) to treat elbow spasticity were included. Active and passive elbow range of motion (aROM and pROM) and modified Ashworth scale (MAS) were measured before (T0) and after the procedure (T1). A questionnaire was administered to investigate patients’ perception of the procedure. Wilcoxon and Mann-Whitney tests were used to assess differences across time points and between the two groups, respectively. Chi-square test was used to compare the frequency of response to the questionnaire.

Results: Wilcoxon test demonstrated a significant improvement of aROM, pROM and MAS for both groups between T0 and T1 (all P<.05). No difference was found in all examined variables and questionnaire between the two groups at T0 and T1.

Conclusion: Selectively treating brachialis muscle didn’t lead to a reduction in efficacy of the procedure on elbow spasticity. In patients with a residual hand function, selective brachialis treatment could preserve the supination granted by biceps brachii and help counterbalancing pronator muscles hyperactivity.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/ultrasound-guided-selective-diagnostic-nerve-block-in-patients-with-elbow-spasticity-a-retrospective-pilot-study/