Shoulder pain and external rotation in spastic hemiplegia do not improve by injection of botulinum toxin A into the subscapular muscle

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 79; no. 5; pp. 581 - 583
• Main Authors: de Boer, K S, Arwert, H J, de Groot, J H, Meskers, C G M, Mishre, A D Rambaran, Arendzen, J H
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.05.2008; BMJ; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Biological and medical sciences; Botulinum toxin; Botulinum Toxins, Type A - therapeutic use; Double-Blind Method; Female; Follow-Up Studies; Hemiplegia - drug therapy; Humans; Injections, Intramuscular; Male; Medical sciences; Middle Aged; Muscle; Neurology; Pain; Pain Measurement; Patients; Pharmacology. Drug treatments; Range of Motion, Articular - drug effects; Shoulder; Shoulder Dislocation - drug therapy; Shoulder Pain - drug therapy; Spasticity; Stroke; Stroke - complications; Peptidases; Bontoxilysin; Nervous system diseases; Enzyme; Motor system disorder; Diseases of the osteoarticular system; Hydrolases; Metalloendopeptidases; Hemiplegia; Painful shoulder; Neurological disorder; Rotation
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.2007.128371

Objective:To study the effect of botulinum toxin A in the subscapular muscle on shoulder pain and humerus external rotation.Methods:22 stroke patients with spastic hemiplegia, substantial shoulder pain and reduced external rotation of the humerus participated in a randomised, double blind, placebo controlled effect study. Injections of either botulinum toxin A (Botox, 2×50 units) or placebo were applied to the subscapular muscle at two locations. Pain was scored on a 100 mm vertical Visual Analogue Scale; external rotation was recorded by means of electronic goniometry. Assessments were carried out at 0 (baseline), 6 and 12 weeks.Results:21 patients completed the study. We observed no significant changes in pain or external rotation as a result of administration of botulinum toxin A. External rotation improved significantly (p = 0.001) for both the treatment group (20.4° (16.6) to 32.1° (14.0)) and the control group (10.3° (19.5) to 23.7° (20.7)) as a function of time.Conclusions:Application of botulinum toxin A into the subscapular muscle for reduction of shoulder pain and improvement of humeral external rotation in spastic hemiplegia does not appear to be clinically efficacious.