Shoulder pain and external rotation in spastic hemiplegia do not improve by injection of botulinum toxin A into the subscapular muscle.
ABSTRACT To study the effect of botulinum toxin A in the subscapular muscle on shoulder pain and humerus external rotation.
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.
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.
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.
Article: Shoulder pain management in stroke[show abstract] [hide abstract]
ABSTRACT: Background: Shoulder pain in stroke survivors has an important negative rol in rehabilitation program. There are a number of known underlying causes of shoulder pain. The most common one is shoulder spasticity, localized on shoulder internal rotators. Matherial and methods: 63 stroke survivors, in a subacute phase of rehabilitation, with comunication and comprehensive facilities, sphincter control, cardiorespiratory stability and shoulder pain. Other causes than spasticity for shoulder pain were excluded. Patients were included in phase-specific rehabilitation program (the degree of joint mobility – Range of Motion – ROM, stretching, occupational therapy for upper leg function) and were randomly assign to transcutaneous electrical nerve stimulation (TENS, 31 patients) and galvanic application (33 patients) on spastic shoulder internal rotators (e.g. subscapularis muscle), for 20 minutes daily, 15 days. Both investigators and patients were blinded. Results: After completion of 15 days-treatments the global functioning parameters showed an improvement in both groups with no differences between them. The pain scores had a better evolution in TENS-group. The upper extremity functional score improved in both groups. TENS-group had better result on proximal motor control than galvanic group and no difference on distal motor control. Conclusion: We found that TENS application was more efficient on pain control and o proximal motor control of upper extremity than galvanic current. The underlying mechanisms of TENS efficiency may relay on pain control and spasticity reduction actions.Maedica A Journal of Clinical Medicine. 01/2008; 3.