Adults With Upper Limb Spasticity

Overview Efficacy Safety Dosing


One of the most common causes of upper limb spasticity in adults is a stroke. After a stroke, signals from the brain to the muscles may not work correctly.1 Signs of spasticity may develop within weeks or over a longer period of time.2

Even if they haven't had a stroke, there are other conditions (listed below) that may cause your adult patient's brain to send the wrong signals to their muscles and cause upper limb spasticity.3,4

Impact of a stroke

Manifestation of spasticity

Diagnosis of post-stroke upper limb spasticity


Adult upper limb spasticity is a clinical problem in which muscles become overactive and tense, leading to difficulty in movement and limits on the ability to perform daily activities.3

Adult patients with upper limb spasticity may experience symptoms including but not limited to4:

Symptoms may have an impact on activities of daily living. The severity of symptoms varies among patients from mild to severe.4

Clinical Presentation of Adults with Upper Limb Spasticity4

Botulinum toxin injections are a level-A recommended option for the treatment of post-stroke spasticity of the upper limb, according to the American Academy of Neurology12

Symptoms may have an impact on activities of daily living. The severity of symptoms varies among patients, from mild to severe.4


  1. Recovery after stroke: movement and balance. National Stroke Association website. Accessed September 21, 2018.
  2. Wissel J, Schelosky LD, Scott J, Christe W, Faiss JH, Mueller J. Early development of spasticity following stroke: a prospective, observational trial. J Neurol. 2010;257(7):1067-1072.
  3. Differential diagnosis for spasticity. NeuroRehab Resource website. September 4, 2018.
  4. Spasticity. American Association of Neurological Surgeons website. Accessed September 4, 2018.
  5. Elovic EP, Munin MC, Kanovsky P, Hanschmann A, Hiersemenzel R, Marciniak C. Randomized, placebo-controlled trial of incobotulinumtoxinA for upper-limb post-stroke spasticity [published online ahead of print]. Muscle Nerve. doi: 10.1002/mus.24776.
  6. Kanovsky P, Slawek J, Denes Z, et al. Efficacy and safety of botulinum neurotoxin NT 201 in poststroke upper limb spasticity. Clin Neuropharmacol. 2009;32(5):259-265.
  7. Barnes M, Schnitzler A, Medeiros L, Aguilar M, Lehnert-Batar A, Minnasch P. Efficacy and safety of NT 201 for upper limb spasticity of various etiologies—a randomized parallel-group study. Acta Neurol Scand. 2010;122(4):295-302.
  8. World Stroke Organization. Accessed 10.12.2018.
  9. Impact of stroke (stroke statistics). American Stroke Association website. Accessed September 21,2018.
  10. Ward AB. A literature review of the pathophysiology and onset of post-stroke spasticity. Eur J Neurol. 2012;19(1):1.
  11. Wissel J, Manack A, Brainin M. Toward an epidemiology of poststroke spasticity. Neurology. 2013;80(3 Suppl 2):1.
  12. Simpson DM, Gracies J-M, Graham HK, et al. Assessment: Botulinum neurotoxin for the treatment of spasticity (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2008;70(19):1691-1698.