title: A randomized controlled study of botulinum toxin A in the treatment of hemiplegic shoulder pain associated with spasticity.
abstract: OBJECTIVE
  To assess the effects of botulinum toxin A (BT-A) on hemiplegic shoulder pain associated with spasticity.
  
  
  METHODS
  Randomized, double-blind, placebo-controlled study.
  
  
  METHODS
  Outpatient clinic of a rehabilitation department.
  
  
  METHODS
  Patients, more than three months post stroke, with hemiplegic shoulder pain associated with shoulder adductor and elbow flexor spasticity, randomly assigned to BT-A or placebo.
  
  
  METHODS
  One-time injection of BT-A (500 units) into the pectoralis major and biceps brachii on the hemiplegic side.
  
  
  METHODS
  Visual analogue scale of shoulder pain (0 -10), shoulder adductor and elbow flexor tone using the Ashworth Scale and passive range of shoulder abduction. These were assessed at baseline, four weeks, eight weeks and 12 weeks post injection.
  
  
  RESULTS
  Seventeen patients were enrolled, eight in the BT-A group and nine in the placebo group. At baseline, the median visual analogue scale score for shoulder pain was 6, the median Ashworth Scale shoulder adductor and elbow flexor spasticity score was 2 and the median range of shoulder abduction 76 degrees. Subjects who received BT-A showed significantly greater improvements in median shoulder adductor and elbow flexor Ashworth Scale scores than placebo at week 4 (P B / 0.01) but not at week 8 and 12. For shoulder pain and passive shoulder abduction range, all subjects showed postinjection improvements and no difference could be demonstrated between the two groups.
  
  
  CONCLUSIONS
  Possible reasons for the negative finding in this study include the small sample size and the presence of causes of shoulder pain not related to spasticity which could have confounded outcome.
authors.affiliation: Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore. keng_he_kong@ttsh.com.sg
authors.forename: Keng-He
authors.initials: KH
authors.lastname: Kong
authors.forename: Jong-Jong
authors.initials: JJ
authors.lastname: Neo
authors.forename: Karen Sg
authors.initials: KS
authors.lastname: Chua
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D006429:Hemiplegia / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000150:complications* / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D020069:Shoulder Pain / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A