1314 - Remarkable improvement of upper arm spasticity after Phenol Injection of radial nerve branches of anconeus muscle.

Case Diagnosis: Upper arm spasticity

Case Description: A previously healthy 29-year-old gentleman who was involved in a vehicle accident 4 months ago with a result of multiple significant injuries including an intraventricular hemorrhage. After the patient's stabilization, the patient was transferred to a long-term acute care hospital. Spasticity of upper and lower extremities was limiting the progress of physical therapy. In particular, the patient had a spastic extension of the elbow that limited range of motion.




Discussions: Phenol injections were used to treat the spasticity multiple times on upper and lower extremities. After multiple attempts of phenol injections to decrease spasticity on the left upper arm, the medical team was unable to show any improvement in left arm tone or range of motion. On the third attempt at phenol neurolysis, a new approach was implemented. This time, Phenol Neurolysis was performed to the Anconeus muscle.
After injection, the patient demonstrated an immediate improvement on left upper arm for spasticity, passive range of motion, and active mobility. The MAS of the elbow after phenol injection of the anconeus was documented as 1 to 2 on the MAS scale by therapists during subsequent therapy interactions.



Conclusions: The anconeus is a small muscle on the posterior aspect of the arm that assists in elbow extension. Due to its small size and complex role in arm movement, it is not typically a candidate for spasticity injections. This case report demonstrates an unusual case of tremendous improvement in spasticity after phenol injection of the anconeus. The MAS score improved between 1-3 grades. The patient was able to demonstrate better positioning in his wheelchair and ADL activities were addressed as able with OT. Physiatrists who inject phenol and toxins for spasticity may need to consider the anconeus in situations where traditional targets do not result in improvement of tone and positioning.