1335 - Motor Point Block as a Palliative Therapy for Severe Post-Stroke Spasticity

The patient is a 72-year-old female who had suffered a left MCA stroke complicated by early onset severe right spastic hemiplegia. Palliative medicine, after attempting to manage spastic pain with IV morphine, consulted PM&R for assistance management. On assessment, there was skin breakdown at the right antecubital area and right axilla. Additionally, increased tone was notable for MAS 3 of the right pectoralis, elbow flexors, and finger flexors. Diagnostic motor point block was performed to the musculocutaneous branches and medial and lateral pectoral nerves upon admission to inpatient rehab. The patient had significant improvement in MAS scores and pain immediately. PT and OT casted the RUE following the procedure. There was improvement in ROM, skin breakdown, and pain after casts were removed. Two weeks later, neurolysis with phenol was performed. The patient again had significant spasticity reduction and pain relief. The patient was eventually transitioned to hospice care.


Discussions: Patients receiving palliative care could benefit from specific physiatric skills to regain or maintain function and independence. Optimal coordination of resources can facilitate patients in regaining function, improve painful or limiting symptoms, and decrease caregiver burden. This case of post-stroke early-onset spasticity, a sign of poor functional prognosis, demonstrated how neurolysis with phenol provided significant pain relief, facilitated hygiene and skin maintenance, and decreased caregiver burden. Additionally, it highlighted the importance of interventional spasticity management in an interdisciplinary treatment plan for spasticity and its potential role in palliative care.  

Conclusions: Patients with critical illnesses causing debility requiring palliative care can benefit from physiatry specific skills in management. In these cases, continued coordination of resources between interdisciplinary teams will best provide holistic, patient-centered care for optimization of function, pain control, and decreased caregiver burden.