ABSTRACT
As with all interventions to aid spasticity management, focal treatments must be given in the context of a multidisciplinary management plan. The selection of appropriate patients and the definition of clear, achievable, realistic and measurable goals are crucial to the successful use of Botulinum Toxin (BoNT) in spasticity management. Chemical neurolysis is an attractive option to manage limb spasticity in some subjects. It consists of a local injection of ethanol or, more commonly, phenol to manage an area of focal spasticity. The most commonly applied neurolysis procedure to the upper limb is blockade of the musculocutaneous nerve to reduce elbow flexor spasticity. The musculocutaneous nerve is a branch of the lateral cord of the brachial plexus and supplies both the biceps and brachialis muscles. The use of focal treatments such as BoNT or chemical neurolysis can avoid potential systemic side effects of escalating oral drug regimes.
