Poster 16: Use of open phenol blocks in the treatment of lower-extremity spasticity in an adult with severe traumatic brain injury: a case report

Abstract

Setting: Free-standing acute rehabilitation facility. Patient: A 37-year-old man with severe traumatic brain injury. Case Description: Physical examination revealed spasticity of bilateral lower extremities (rated as a 4 on the Ashworth Scale) resulting in severe equinovarus deformities. This resulted in the patient’s inability to stand, transfer, and ambulate. Treatments with positioning, splinting, serial casting, dantrolene, transcutaneous phenol blocks, and botulinum toxin type A injections showed no improvements. Further investigation of spasticity management revealed another treatment option. Open phenol blocks to the bilateral tibial nerves at the popliteal fossa were performed. The patient tolerated the procedure well. Assessment/Results: 2 weeks after bilateral open phenol blocks, the patient’s ankle range of motion improved. He was able to maintain both feet in a neutral position and that led to an increased ability to aid in transfers and standing. With physical therapy and casting, the patient was able to ambulate using a walker. Discussion: Although open phenol blocks were once well-known procedures, they are no longer considered current treatment options. Conclusion: This case demonstrates the effectiveness of injecting phenol directly into the nerve to decrease spasticity. An open phenol block is an effective treatment of severe spasticity and should be considered.