A COMPARATIVE STUDY BETWEEN EFFICACIES OF USG GUIDED BOTULINUM TOXIN INJECTION INTO THE SUBSCAPULARIS MUSCLE AND THE CONSERVATIVE TREATMENT IN HEMIPLEGIC SHOULDER PAIN

Abstract

Introduction: Hemiplegic shoulder pain (HSP) is a common complication after stroke. HSP inhibits recovery and rehabilitation and impairs the quality of life of stroke survivors. Although the etiology of HSP is not well known, it has been suggested that multiple factors contribute to HSP. Our approach is to compare the efcacy of USG guided Botulinum toxin injection into the subscapularis muscle and conservative treatment in case of intractable hemiplegic shoulder pain. Material and methods: In this Parallel Group Open Level Randomized Controlled Trial, conducted in the Department of Physical Medicine and Rehabilitation, IPGME&R, SSKM Hospital, Kolkata between September, 2017 to September, 2018 (Twelve months) on 34 (17 in each group) patients with intractable (persistent pain for more than 3 months) hemiplegic shoulder pain. In group 1, Botulinum toxin injection was given in subscapularis muscle by USG guided lateral approach. In group 2, managed conservatively with Physical therapy (stretching, passive range of motion exercise), Modality (hot pack, infrared, IFT), pain medications (NSAIDS, oral opioids) and Neuromuscular electrical stimulation of shoulder. Parameters used: 1. Pain intensity - measured by Numerical Rating Scale (NRS) [Score 0- 10], 2. Spasticity measured by - Modied Ashworth Scale (MAS) [score 0-4], 3. Shoulder range of motion - External rotation (ER) [score 0- 90] assessed. The patients attending the Physical Medicine and Rehabilitation OPD at IPGME&R and SSKM Hospital, Kolkata were included and studied if they fullled the inclusion and nd exclusion criteria after getting Institutional Ethics Committee clearance and informed written consent. After initial visit, followed up on 2 week, th th 4 week and 12 week. Comparison done considering all the parameters considering basal and follow up data to compare the efcacy of intramuscular botulinum toxin injection and those with in group 2, managed conservatively. Results: All the data collected during this study period were analyzed by using statistical software Statistica vertsion 6 [Tulsa, Oklahoma: StatSoft Inc., 2001] and GraphPad Prism version 4 [San Diego, California: GraphPad Software Inc., 2005]. There was statistically signicant difference (group 1 is statistically superior than group 2) between two groups at 2nd, 4th and 12th week in respect to NRS, MAS of subscapularis and ER of shoulder joint (p value<0.05). Conclusion: There was signicant short-term improvement of shoulder pain, spasticity of shoulder internal rotator(subscapularis) and range of motion in the form of external rotation after Botulinum toxin injection compared to conservative treatment. But in terms of intermediate-term and long-term follow-up although both groups showed signicant improvement but Botulinum toxin injection group was statistically superior than conservative treatment.