Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain

Arch Phys Med Rehabil. 2011 Jul;92(7):1034-7. doi: 10.1016/j.apmr.2011.01.015.

Abstract

Objective: To evaluate the efficacy of intra-articular injection of botulinum toxin type A (BTX-A) in relieving hemiplegic shoulder pain (HSP).

Design: Pilot study with assessments before and after BTX-A intra-articular injection.

Setting: Hospital rehabilitation department.

Participants: 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.

Intervention: Intra-articular BTX-A injection.

Main outcome measure: 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.

MeSH terms

  • Aged
  • Botulinum Toxins, Type A / therapeutic use*
  • Female
  • Hemiplegia / complications
  • Hemiplegia / etiology
  • Humans
  • Injections, Intra-Articular
  • Male
  • Middle Aged
  • Neuromuscular Agents / therapeutic use*
  • Pain Measurement
  • Pain, Intractable / drug therapy*
  • Pain, Intractable / etiology
  • Pilot Projects
  • Shoulder Pain / drug therapy*
  • Shoulder Pain / etiology
  • Stroke / complications
  • Treatment Outcome

Substances

  • Neuromuscular Agents
  • Botulinum Toxins, Type A