Spasticity refers to muscles that go into permanent spasm with resultant deformity, disability and even pain. The surgical application for spasticity has been used for many years in children who suffer from birth-related ischaemic events (like Cerebral Palsy) but also in adults who have suffered from a stroke. This typically presents with spasticity on one or sides called hemiplegia and might be expressed in different severities in the upper and lower limb. Typically, in the upper limb, we see the internal rotation of the shoulder, flexion deformity of the elbow, pronation deformity of the forearm, flexion deformity of the wrist and multiple variations of finger and thumb deformities. In the early phase, Botox serves as an excellent treatment modality to relax spastic muscles, before deformity becomes static.

The Botulinum Toxin binds to presynaptic cholinergic nerve terminals selectively, preventing the "message" from going through to the muscle to contract. It prevents the neurotransmitter acetylcholine from being released, preventing muscle contraction. Treatment is usually effective for approximately 3-6 months.

There are other uses for Botox in the upper limb like axillary hyperhidrosis (overt sweating), spastic neck muscles as well as some hand vascular conditions where Botox treatment could be effective.

Botox treatment generally requires a multidisciplinary approach with physios and/or neurologists and even caregivers to balance the required treatment.