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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Adult, Aged, Botulinum Toxins, Type A, Double-Blind Method, Female, Follow-Up Studies, Hemiplegia, Humans, Injections, Intramuscular, Male, Middle Aged, Pain Measurement, Range of Motion, Articular, Shoulder Dislocation, Shoulder Pain, Stroke.
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Do shoulder pain and external rotation in spastic hemiplegia improve by injection of botulinum toxin A into the subscapular muscle? Context: To study the effect of botulinum toxin A in the subscapular muscle on shoulder pain and humerus external rotation. 22 stroke patients with spastic hemiplegia, substantial shoulder pain and reduced external rotation of the humerus participated in a randomised, double blind, placebo controlled effect study. Injections of either botulinum toxin A (Botox, 2x50 units) or placebo were applied to the subscapular muscle at two locations. Pain was scored on a 100 mm vertical Visual Analogue Scale; external rotation was recorded by means of electronic goniometry. Assessments were carried out at 0 (baseline), 6 and 12 weeks. 21 patients completed the study. We observed no significant changes in pain or external rotation as a result of administration of botulinum toxin A. External rotation improved significantly (p = 0.001) for both the treatment group (20.4 degrees (16.6) to 32.1 degrees (14.0)) and the control group (10.3 degrees (19.5) to 23.7 degrees (20.7)) as a function of time.
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Application of botulinum toxin A into the subscapular muscle for reduction of shoulder pain and improvement of humeral external rotation in spastic hemiplegia does not appear to be clinically efficacious. Final Decision: no