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Shoulder pain and external rotation in spastic hemiplegia do not improve by injection of botulinum toxin A into the subscapular muscle.

de Boer KS, Arwert HJ, de Groot JH, Meskers CG, Mishre AD, Arendzen JH

Department of Rehabilitation Medicine, Leiden University Medical Centre B0-Q, PO Box 9600, 2300 RC Leiden, The Netherlands. k.s.de_boer@lumc.nl

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.

Published 14 April 2008 in J Neurol Neurosurg Psychiatry, 79(5): 581-3.
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