Efficacy of Intra-Articular Injection of Botulinum Toxin Type A in Refractory Hemiplegic Shoulder Pain

Castiglione A, Bagnato S, Boccagni C, Romano MC, Galardi G. Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain. Arch Phys Med Rehabil 2011;92:1034-7. 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 degrees 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.