Upper Limb Spasticity

Updated: July 17, 2023

Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

incobotulinumtoxinA

Treatments should be administered no less frequently than once every 12 weeks.
Initial dose should start at the low end of the prescribed dosing range and be titrated as clinically appropriate if the patient has not previously had treatment with botulinum toxins.
400 units maximum cumulative dosage per treatment session
Recommended dose per muscle
Clenched fist
25-100 units divided in 2 sites: Flexor digitorum superficialis Flexed wrist
25-100 units divided in 1-2 sites: Flexor carpi radialis
20-100 units divided in 1-2 sites: Flexor carpi ulnaris
Flexed elbow
25-100 units divided in 1-3 sites: Brachioradialis
50-200 units divided in 1-4 sites: Biceps
25-100 units divided in 1-2 sites: Brachialis
Pronated forearm
10-50 units in 1 site: Pronator quadratus
25-75 units divided in 1-2 sites: Pronator teres
Thumb-in-palm
10-50 units in 1 site: Flexor pollicis longus
5-30 units in 1 site: Adductor pollicis
5-30 units in 1 site: Flexor pollicis brevis

incobotulinumtoxinA

Treatments should be administered no less frequently than once every 12 weeks.
a solitary upper limb: 200 units per upper limb, split among the afflicted muscles, is the maximum dosage.
Treatment is given to both upper limbs: Limit the total dosage to no more than 400 units, not to exceed 16 units/kg.
Dosage range per muscle
1–2 units/kg (up to 50 units) distributed at 1–2 sites: Brachioradialis
2-3 units/kg (up to 75 units), distributed across 1-3 sites: Biceps
1–2 units/kg (up to 50 units) distributed at 1–2 sites: Brachialis
1 unit/kg (up to 25 units) at a single site: Radial flexor carpi muscle
1 unit/kg (up to 25 units) at a single site: Flexor ulnaris carp
0.5 unit/kg (up to 12.5 units) at a single site: Infraorbital quadratus
50 units maximum, divided between 1-2 sites at 1-2 units/kg: Pronator teres
1 unit/kg (up to 25 units) at a single site: digitorum flexor superficialis
1 unit/kg (up to 25 units) at a single site: digitorum flexor profundus
1 unit/kg (up to 25 units) at a single site: flexor pollicis longus
0.5 unit/kg (upto to 12.5 units) at a single site: Adductor pollicis
0.5 unit/kg (upto of 12.5 units) at a single site: Flexor pollicis brevis