A 70-year-old woman with a left MCA stroke has severe right arm spasticity with a tightly flexed elbow, wrist, and fingers. She has painful

Question

A 70-year-old woman with a left MCA stroke has severe right arm spasticity with a tightly flexed elbow, wrist, and fingers. She has painful contracture formation at the wrist despite botulinum toxin injections and splinting. Serial casting has been tried. What is the next management option?

Accepted Answer

Refer for surgical assessment of tendon lengthening or release to improve care and comfort

Answer

Increase botulinum toxin beyond approved dosing limits because fixed contracture remains after prior injections

Answer

Continue unchanged splinting alone because fixed contracture does not cause pain or hygiene difficulty

Answer

Use maximum-dose oral dantrolene as a substitute for structural assessment of the contracture

Answer

Insert an intrathecal baclofen pump as first-line treatment for the isolated fixed wrist deformity

Post-Stroke Contracture – Surgical Consideration — SCE Neurology MCQ

A 70-year-old woman with a left MCA stroke has severe right arm spasticity with a tightly flexed elbow, wrist, and fingers. She has painful contracture formation at the wrist despite botulinum toxin injections and splinting. Serial casting has been tried. What is the next management option?