1319 - Distinguishing Contracture From Spasticity in Hemiplegic Stroke: An Interdisciplinary Approach.

Case Diagnosis: Spasticity can be a debilitating sequelae of neurological disorders and pose a threat to patient safety when their ADLs are compromised. Epidural motor blockade can be a useful diagnostic tool to help differentiate between spasticity and musculotendinous contracture when the clinical examination is inconclusive. This case demonstrated an interdisciplinary approach to patient care involving Interventional Pain as well as PM&R physicians.

Case Description: Our patient is a 78 year old male who suffered a left MCA stroke in 2017 that left him with severe right sided spastic hemiplegia. His ADLs and community integration were significantly compromised due to his extensor posturing in his paretic lower extremity. It became a cause of frequent falls out of his power chair and total dependence for all transfers. His rehab team inquired if there were any procedures that could assist in determining whether or not he had reversible spasticity or true contracture, as treatment diverges once the distinction is determined. It was decided to trial an epidural motor block with local anesthetic accompanied by immediate pre & post procedural physical exams by our Physical Medicine and Rehabilitation colleagues.

Discussions: The patient's pre-procedural physical exam was concerning for lower extremity contractures, but following the motor blockade, his exam displayed significant improvement in his range of motion and MAS. His hip flexion was significantly improved by around 60 degrees, and functionally he was able to be safely positioned in his power wheelchair and maintain that positioning without a seatbelt for the first time.

Conclusions: Overall our case report is unique in that the motor blockade was able to be a useful clinical tool in determining if this patient had a contracture that would require tendon lengthening surgery, or if he had spasticity and would better benefit from less invasive measures, such as botox or baclofen pump implantation.