title: Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain.
abstract: OBJECTIVE
  To evaluate the efficacy of intra-articular injection of botulinum toxin type A (BTX-A) in relieving hemiplegic shoulder pain (HSP).
  
  
  METHODS
  Pilot study with assessments before and after BTX-A intra-articular injection.
  
  
  METHODS
  Hospital rehabilitation department.
  
  
  METHODS
  Patients (N=5) with HSP refractory to standard treatments and pain score at rest greater than 7 on a pain visual analog scale (VAS) of 0 to 10cm.
  
  
  METHODS
  Intra-articular BTX-A injection.
  
  
  METHODS
  Variation in VAS score at rest and during 90° passive arm abduction 2 and 8 weeks after BTX-A intra-articular injection.
  
  
  RESULTS
  Baseline VAS score was 8.7±1 at rest and 9.8±0.4 during passive arm abduction. It clearly decreased at 2 (1.5±1.1 at rest, P=.001; 3±1.2 during arm abduction, P<.001) and 8 weeks (1.5±1.2 at rest, P=.001; 2.3±1.1 during arm abduction, P<.001) after BTX-A intra-articular injection.
  
  
  CONCLUSIONS
  We found a strong correlation between intra-articular BTX-A injection and pain relief in patients with HSP. This result could provide the rationale for blind randomized controlled trials designed to better evaluate the safety and efficacy of intra-articular BTX-A injection in patients with refractory HSP.
authors.affiliation: Department of Rehabilitation, Fondazione Istituto San Raffaele-G. Giglio, Cefalù Palermo, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Castiglione
authors.forename: Sergio
authors.initials: S
authors.lastname: Bagnato
authors.forename: Cristina
authors.initials: C
authors.lastname: Boccagni
authors.forename: Marcello C
authors.initials: MC
authors.lastname: Romano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Galardi
mesh_terms: D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006429:Hemiplegia / Q000150:complications / Q000209:etiology; D006801:Humans; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology; D010865:Pilot Projects; D020069:Shoulder Pain / Q000188:drug therapy* / Q000209:etiology; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A