Article Text

PDF
Shoulder pain and external rotation in spastic hemiplegia do not improve by injection of botulinum toxin A into the subscapular muscle
  1. K S de Boer1,
  2. H J Arwert2,
  3. J H de Groot1,
  4. C G M Meskers1,
  5. A D Rambaran Mishre2,
  6. J H Arendzen1
  1. 1
    Department of Rehabilitation Medicine, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2
    Sophia Rehabilitation Centre, The Hague, The Netherlands
  1. K S de Boer, Department of Rehabilitation Medicine, Leiden University Medical Centre B0-Q, PO Box 9600, 2300 RC Leiden, The Netherlands; k.s.de_boer{at}lumc.nl

Abstract

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, 2×50 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° (16.6) to 32.1° (14.0)) and the control group (10.3° (19.5) to 23.7° (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.

Statistics from Altmetric.com

Footnotes

  • Funding: The study was approved by the medical ethics committee of Leiden University Medical Centre, Leiden, The Netherlands.

  • Competing interests: None.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.