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Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: A randomized, double-blind, placebo-controlled study of botulinum toxin A
  1. Alain P yelnik (alain.yelnik{at}
  1. AP-HP GH Lariboisière-F.Widal APHP, University Paris7, France
    1. Florence M Colle (f.colle{at}
    1. AP-HP, G.H. Lariboisière-F.Widal, University Paris7, France
      1. Isabelle V Bonan (isabelle.bonan{at}
      1. AP-HP, G.H. Lariboisière-F.Widal, University Paris7, France
        1. Eric Vicaut (eric.vicaut{at}
        1. AP-HP, G.H. Lariboisière-F.Widal, University Paris7, France


          Objective: This randomized, double-blind, placebo-controlled, 2 parallel-group study was conducted to assesss the beneficial effect of Botulinum toxin A (DysportÒ) injection into the subscapularis muscle on shoulder pain in stroke patients with spastic hemiplegia.

          Methods: A single injection of Botulinum toxin A (500 Speywood units) or placebo was made in the subcapularis muscle. Pain was assessed using a 10-point verbal scale. Subscapularis spasticity was assessed by the change in passive shoulder lateral rotation and abduction. Upper limb spasticity was assessed using the Modified Ashworth Scale for shoulder medial rotators, and elbow, wrist and finger flexors. Assessments were carried out at baseline and Weeks 1, 2 and 4.

          Results: Twenty patients (10 patients per group), 11 with an ischemic stroke, 9 with a haemorrhagic stroke, completed the study. Pain improvement with Botulinum toxin A was observed from Week 1; score difference from baseline at Week 4 was 4 points versus 1 point with placebo (p = 0.025). Lateral rotation was also improved, with difference versus placebo statistically significant at Week 2 (p = 0.05) and Week 4 (p = 0.018). A general improvement of upper limb spasticity was observed; it was significant for finger flexors at Week 4 (p = 0.025).

          Conclusions: Subscapularis injection of Botulinum toxin A appears to be of value in the management of shoulder pain in spastic hemiplegic patients. The results confirm the role of spasticity in post-stroke shoulder pain.

          • Botulinum toxin
          • pain
          • shoulder
          • spasticity
          • stroke

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