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Alberto Castiglione, MD, Sergio Bagnato, MD, PhD, Cristina Boccagni, MD, Marcello C. Romano, MD, Giuseppe Galardi, MD


Castiglione A, Bagnato S, Boccagni C, Ro- mano 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 in- jection 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° 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 con- trolled trials designed to better evaluate the safety and efficacy of intra-articular BTX-A injection in patients with refractory HSP.
Key Words: Botulinum toxin type A; Intra-articular injec- tion; Refractory pain; Rehabilitation; Shoulder pain; Stroke.
© 2011 by the American Congress of Rehabilitation Medicine