Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A
Open Access
- 1 August 2007
- journal article
- research article
- Published by BMJ in Journal of Neurology, Neurosurgery & Psychiatry
- Vol. 78 (8) , 845-848
- https://doi.org/10.1136/jnnp.2006.103341
Abstract
Objective: This randomised, double blind, placebo controlled, two parallel group study was conducted to assess the beneficial effect of injection of botulinum toxin A (Dysport) into the subscapularis muscle on shoulder pain in stroke patients with spastic hemiplegia. Methods: A single dose of botulinum toxin A (500 Speywood units) or placebo was injected into the subcapularis muscle. Pain was assessed using a 10 point verbal scale. Subscapularis spasticity was assessed by the change in passive shoulder lateral rotation and abduction. Upper limb spasticity was assessed using the Modified Ashworth Scale for shoulder medial rotators, and elbow, wrist and finger flexors. Assessments were carried out at baseline and at weeks 1, 2 and 4. Results: Twenty patients (10 patients per group), 11 with ischaemic stroke and 9 with haemorrhagic stroke, completed the study. Pain improvement with botulinum toxin A was observed from week 1; score difference from baseline at week 4 was 4 points versus 1 point with placebo (p = 0.025). Lateral rotation was also improved, with a statistically significant difference compared with placebo at week 2 (p = 0.05) and week 4 (p = 0.018). A general improvement in upper limb spasticity was observed; it was significant for finger flexors at week 4 (p = 0.025). Conclusions: Subscapularis injection of botulinum toxin A appears to be of value in the management of shoulder pain in spastic hemiplegic patients. The results confirm the role of spasticity in post-stroke shoulder pain.Keywords
This publication has 21 references indexed in Scilit:
- Treatment of Pain and Limited Movement of the Shoulder in Hemiplegic Patients with Botulinum Toxin A in the Subscapular MuscleEuropean Neurology, 2003
- Intramuscular Injection of Botulinum Toxin for the Treatment of Wrist and Finger Spasticity after a StrokeNew England Journal of Medicine, 2002
- Effect of Intramuscular Botulinum Toxin Injection on Upper Limb Spasticity in Stroke PatientsAmerican Journal of Physical Medicine & Rehabilitation, 2002
- Clinical Factors in the Prognosis of Complex Regional Pain Syndrome Type I After StrokeAmerican Journal of Physical Medicine & Rehabilitation, 2002
- A randomized, double‐blind, placebo‐controlled study of the efficacy and safety of botulinum toxin type A in upper limb spasticity in patients with strokeEuropean Journal of Neurology, 2001
- A Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging Study to Compare the Efficacy and Safety of Three Doses of Botulinum Toxin Type A (Dysport) With Placebo in Upper Limb Spasticity After StrokeStroke, 2000
- Effect of Triamcinolone Acetonide Injections on Hemiplegic Shoulder PainStroke, 2000
- Impact of botulinum toxin type A on disability and carer burden due to arm spasticity after stroke: a randomised double blind placebo controlled trialJournal of Neurology, Neurosurgery & Psychiatry, 2000
- Prediction of muscle force involved in shoulder internal rotation.2000
- A double-blind placebo-controlled study of botulinum toxin in upper limb spasticity after stroke or head injuryClinical Rehabilitation, 2000