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Treatment of Focal Muscle Stiffness with Hyaluronidase Injections

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Spasticity and Muscle Stiffness

Abstract

Spasticity develops because of injury to the central nervous system. However, secondary changes within the connective tissue of the muscle also contribute to muscle stiffness. The hyaluronan hypothesis postulates that the accumulation and biophysical alteration of hyaluronan, a high molecular weight glycosaminoglycan that normally acts as a lubricant within the extracellular matrix of muscles, promotes the development of muscle stiffness and progression to fibrosis and muscle contracture. Intramuscular injections of the enzyme hyaluronidase, which catabolizes the altered hyaluronan polymer, were shown to reduce muscle stiffness and increase passive and active range of motion in patients with spasticity-associated muscle stiffness. This chapter discusses the preliminary evidence for the emerging treatment of muscle stiffness using the enzyme hyaluronidase and its potential to prevent fibrosis and contracture.

…the beauty and strength of the mechanical construction lie not in one part or in another, but in the harmonious concatenation which all the parts, soft and hard, rigid and flexible, tension bearing and pressure bearing, make up together.—D’Arcy Thompson, On Growth and Form, 1917.

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  • 29 October 2022

    P. Raghavan (ed.), Spasticity and Muscle Stiffness,

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Disclosures

This chapter discusses the off-label use of hyaluronidase for treatment of muscle stiffness. Drs. Preeti Raghavan and Antonio Stecco are co-founders of MovEase, Inc.

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Authors and Affiliations

  1. Departments of Physical Medicine and Rehabilitation and Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Preeti Raghavan

  2. Albert Einstein College of Medicine, Bronx, NY, USA

    Alexandra Gordon

  3. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ryan Roemmich

  4. Rusk Rehabilitation, NYU Grossman School of Medicine, New York, NY, USA

    Antonio Stecco

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  1. Preeti Raghavan
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  2. Alexandra Gordon
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  3. Ryan Roemmich
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  4. Antonio Stecco
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Correspondence to Antonio Stecco .

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Editors and Affiliations

  1. Departments of Physical Medicine and Rehabilitation and Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Preeti Raghavan

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Raghavan, P., Gordon, A., Roemmich, R., Stecco, A. (2022). Treatment of Focal Muscle Stiffness with Hyaluronidase Injections. In: Raghavan, P. (eds) Spasticity and Muscle Stiffness. Springer, Cham. https://doi.org/10.1007/978-3-030-96900-4_13

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