Comparative Study between Effectiveness of Ultrasound-guided ONA-botulinum Toxin Type A Injection with Exercise Therapy on Shoulder Pain Due to Post-stroke Subscapularis Spasticity

Abstract

Background: Several invasive and non-invasive procedures are effective in post-stroke shoulder pain (PSP). In this study, we wanted to assess the role of early intervention by ultrasound-guided botulinum toxin type A injection in shoulder pain due to post-stroke subscapularis spasticity. Methods: This study was a prospective randomised open-label control trial. Patients suffering from PSP due to subscapularis spasticity were selected (n = 80). After computer-generated randomisation, they were allocated into two groups (Group 1: patients on exercise therapy only and Group 2: botulinum toxin injection in subscapularis along with exercise therapy) consisting of 40 patients in each group. The primary outcome measure was Visual Analogue Scale (VAS) score of shoulder pain. The secondary outcome measures were Shoulder Pain and Disability Index (SPADI) and Modified Ashworth Scale (MAS) for spasticity of subscapularis. Results: Statistically significant differences in improvement were found with superior result in Group 2 at 2 weeks for shoulder pain VAS (P = 0.025), SPADI (P = 0.047) and MAS (P = 0.038); at 6 weeks for shoulder pain VAS (P = 0.019), SPADI (P = 0.037) and MAS (P = 0.041); and at 12 weeks for shoulder pain VAS (P = 0.011), SPADI (P = 0.027) and MAS (P = 0.035). No adverse effect was observed in either of the group. Conclusion: In clinical practice, botulinum toxin injection is regarded as the first-choice treatment of focal spasticity in the upper limb, as it gives us the opportunity to target specifically selected muscles. Botulinum toxin injection along with exercise therapy is more effective in early intervention of PSP due to subscapularis spasticity to improve shoulder pain and function.

Keywords

• botulinum toxin
• shoulder pain
• spasticity
• stroke