Hemiplegic shoulder pain: Comparison of two sites of intramuscular injections of botulinum toxin type A, "epautox" study.

OBJECTIVE: The aim of this study was to compare the analgesic effectiveness of 1 month injection after botulinum toxin in the pectoralis major muscle or subscapularis.

MATERIAL/PATIENTS AND METHODS: In this prospective, comparative, randomized, multicenter trial, 21 patients with hemiplegic shoulder pain after a recent stroke (less 6 months) were screened at baseline, then postinjection (Botox(®) 150 units pectoralis major, 100 units subscaplaris) at 1, 4 and 12 weeks. Outcomes were pain (assessed by visual analogic scale), range of motion, spasticity (Ashworth).

RESULTS: Pain improve significatively in subscapularis injection since the first month (P=0.027), but without significant difference between both groups (P=0.50). Pain score decreases from baseline, at respectively 4 and 12 weeks, of 16.3 and 24 points in subscapularis group versus 19.2 and 7.6 points in pectoralis major group.

DISCUSSION - CONCLUSION: Subscapularis injection offers a more linear evolution of pain and shoulder range of motion than pectoralis major injection. This study points out a role of toxin in the management hemiplegic shoulder pain.