Shoulder pain and external rotation in spastic hemiplegia do not improve by injection of botulinum toxin A into the subscapular muscle.
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, 2x50 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 degrees (16.6) to 32.1 degrees (14.0)) and the control group (10.3 degrees (19.5) to 23.7 degrees (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.
de Boer
K S
KS
Department of Rehabilitation Medicine, Leiden University Medical Centre B0-Q, PO Box 9600, 2300 RC Leiden, The Netherlands. k.s.de_boer@lumc.nl
Arwert
H J
HJ
de Groot
J H
JH
Meskers
C G M
CG
Mishre
A D Rambaran
AD
Arendzen
J H
JH
D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006429:Hemiplegia / Q000188:drug therapy*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000187:drug effects*; D012783:Shoulder Dislocation / Q000188:drug therapy*; D020069:Shoulder Pain / Q000188:drug therapy*; D020521:Stroke / Q000150:complications*
D019274:Botulinum Toxins, Type A