Disclosures: Eduardo M. Rocha, MD: No financial relationships or conflicts of interest

Objective: Assess whether the use of botulinum toxin in the treatment of Painful Hemiplegic Shoulder Syndrome (PHSS) modifies the pain intensity of these patients when compared to patients who received placebo with saline solution after one and four months.

Design: A prospective, with two parallel arms, double-blind, randomized and placebo controlled. clinical trial study was conducted in two different Rehabilitation Centers. The study was logged in the Clinical Trials platform under the number NCT04470401.

Setting: Two Distinct Neurological Rehabilitation Centers

Participants: Patients who were included presented: Adults with spastic motor sequelae in the upper limb resulting from ischemic or hemorrhagic stroke, with diagnosis of PHSS independent of motor dominance.

Interventions: The muscles selected for this treatment were pectoralis major and subscapularis muscles, which were each treated with 200 U of abobotulinumtoxin at two different points per muscle with the same dosage (100 u per point). The application was guided by use of electrostimulation or ultrasound.

The evaluations were performed at the treatment start, one, and four months after the procedure.

Main Outcome Measures: Visual Analog Scale (VAS), Manual Goniometry (ranges of external rotation and shoulder abduction, both active and passive ), Modified Asworth Scale (MAS), McGill pain questionnaire, Fugl -Meyer Test (FM) for measuring upper limb function.

Results: Improvement in pain and spasticity levels in both groups without statistical significance. The results showed a reduction in pain by VAS and by the McGill scale (p=0.52 and 0.37), a reduction in spasticity by the Ashworth scale in internal rotators and shoulder adductors (p=0.86 and p=0.83), gain in shoulder joint range of motion for external rotation and abduction (p=0.71 and p=0.98), functional gain by the scale of Fugl- Meyer (p=0.70).

Conclusions: The use of botulinum toxin in the subscapularis and pectoralis major muscles resulted in a not statistically different reduction in shoulder pain in spastic hemiplegic patients.

Level of Evidence: Level I

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/use-of-botulinum-toxin-type-a-as-a-treatment-of-painful-hemiplegic-shoulder-syndrome/