Brief report| Volume 92, ISSUE 7, P1034-1037, July 2011

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.


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


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


      Hospital rehabilitation department.


      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.


      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.


      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.


      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.

      Key Words

      List of Abbreviations:

      BTX-A (botulinum toxin type A), HSP (hemiplegic shoulder pain), VAS (visual analog scale)
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