Effectiveness of ultrasound guided ethanol motor points block in reduction of spasticity and improvement of upper limb function in hemiplegic patients: a randomized controlled study

Sreejith C., Akoijam Joy Singh, Longjam Nilachandra Singh, Kanti Rajkumari, Margaret Chabungbam, Chandrakant Pilania, Janet Moirangthem


Background: Stroke is the third leading cause of disability in general population commonly causing upper motor neuron syndrome complications like spasticity, which is more common in upper limb. Ethanol injection into spastic muscle is an emerging effective treatment in the spasticity management. Ethanol causes selective destruction of nerve fibers through denaturation of protein.

Methods: A randomized controlled study was conducted for a period of 2 years from March 2018 on sixty-eight hemiplegic patients to assess the effectiveness of ethanol muscle block in reduction of spasticity and improvement in functional ability. The patients were allocated into two groups (Group A and B). Group A received ultrasound guided intramuscular ethanol injection along with range of motion (ROM) exercises and wrist hand orthosis (WHO) and Group B received ROM exercises and WHO. The outcomes were measured by modified ashworth scale (MAS) for spasticity and modified version of motor assessment scale for functional improvement.

Results: Intervention group showed significant improvement in spasticity shown by reduction of MAS of elbow flexors from 3 at baseline to 1.15±0.3 at 12 weeks as compared to control group with 3 at baseline to 1.76±0.5 at 12 weeks (p<0.05). Upper limb function scale of study group improved from 1.5±0.8 to 3.0±0.6 at 12 weeks compared to control group 1.3±0.8 to 2.8±0.6 (p<0.05).

Conclusions: It can thus be concluded that intramuscular injection of ethanol accompanied by wrist hand orthosis have beneficial effect on improvement of spasticity and upper limb function.


Ethanol block, Modified ashworth scale, Motor assessment scale, Spasticity

Full Text:



Park K. Park’s Textbook of preventive and social medicine. 25th ed. Jabalpur: M/S Banarsidas Bhanot; 2017.

Francisco GE, Li S. Spasticity. In: Cifu DX editor. Physical Medicine and Rehabilitation. 5th Edn. Philadelphia: Elsevier; 2016:487-494.

Wilton JC. Hand Splinting: Principles of design and fabrication. London: WB Saunders; 1997.

Bittencourt PCT, Tournier MB. Phenol block for spasticity management. Acta Fisiatr. 2008;15(7):189-91.

Glenn MB. The practical management of spasticity in children and adults. Philadelphia: Lea and Febieger; 1990.

Elkousy H, Gartsman GM, Drake G, Sola W, O’Conner D, Edwards TB. Retrospective comparison of freehand and ultrasound guided shoulder steroid injections. Orthopedics. 2011;34(4):270-81.

Kong KH, Chua KSG. Neurolysis of the musculocutaneous nerve with alcohol to treat post-stroke elbow flexor spasticity. Arch Phys Med Rehabil. 1999;80(10):1234-36.

Akoijam JS, Longjam O, Longjam NS, Thongjam OS, Yumnam NS, Wangjam K. Prevalence of hemiplegic shoulder pain in post-stroke patients- a hospital based study. IJPMR. 2012;23(1):15-9.