Intra-articular injection of botulinum toxin type A for shoulder pain in glenohumeral osteoarthritis: a case series summary and review of the literature

Figures & data

Table 1 Key and reviewed studies on the employment of intra-articular botulinum toxin type A (BoNT-A)

Study	Design	Duration	Joint	Indication	Age, years	Patients (n)	BoNT-A injected	Main outcome measures	Main results
Mahowald et al^Citation10	Case series	12 months	Knee/ankle/shoulder	Chronic arthritis (OA, RA, psoriatic)	42–82	11 (15 joints)	25–100 U (onabotulinumtoxinA)	NRS, active ROM, TST	Maximum decrease in pain 55% (lower extremity) and 71% (shoulder)
Singh et al^Citation11	RCT	1 month	Shoulder	Shoulder OA	Mean 71	36 (43 joints)	100 U (unspecified)	VAS, SPADI, active ROM, SF-36, McGill Pain Questionnaire	61% of patients had 30% or ≥2 cm decrease in pain severity
Boon et al^Citation12	RCT, double blind, prospective	6 months	Knee	Knee OA	>40	60	100 or 200 U (unspecified)	VAS, WOMAC, SF-36, PGA, 40 m WT	VAS significantly improved in low-dose BoNT-A patients
Chou et al^Citation16	Prospective	6 months	Knee	Knee OA	>60	24 (38 joints)	100 U (onabotulinumtoxinA)	WOMAC	Effects clinically significant at 1 month after the first injection; WOMAC pain reduction at 3 months significant in stage 3 (Kellgren–Lawrence) patients, but not in stage 4
Joo et al^Citation14	RCT, prospective	8 months	Shoulder	Adhesive capsulitis	18–70	28	200 U (abobotulinumtoxinA)	NRS, active ROM	No significant differences between the 2 groups (BoNT-A and triamcinolone acetate)
Sun et al^Citation15	RCT, assessor-blinded	6 months	Ankle	Ankle OA		70	100 U (onabotulinumtoxinA)	AOS, AOFAS, VAS, SLST, TUG	No significant differences between the two groups (BoNT-A and hyaluronate)
Hsieh et al^Citation13	RCT, prospective	6 months	Knee	Knee OA	>45	46	100 U (onabotulinumtoxinA)	VAS, WOMAC, Lequesne index	Pain VAS scores in the BoNT-A group significantly decreased

Abbreviations: AOFAS, American Orthopedic Foot and Ankle Score; AOS, Ankle Osteoarthritis Scale; NRS, numeric rating scale; OA, osteoarthritis; PGA, patient global assessment; RA, rheumatoid arthritis; RCT, randomized clinical trial; ROM, range of motion; SF-36, 36-item short form health survey; SLST, single-leg stance test; SPADI, Shoulder Pain and Disability Index; TST, Timed Stands Test; TUG, timed up-and-go; VAS, visual analog scale; WOMAC, Western Ontario and McMaster Universities Arthritis Index; WT, walking test.

Figure 1 Glenohumeral injection technique with botulinum toxin A.

Table 2 Demographic characteristics of patients and outcome measures at baseline (T0) and after 4 weeks (T1)

Age, years	Sex	Pain onset (months)	VAS at rest (mm)		VAS during active movement (mm)		Constant–Murley score
			T0	T1	T0	T1	T0		T1
							Pain + activity	Mobility + strength	Pain + activity	Mobility + strength
45	M	12	30	0	80	40	13	24	25	40
37	F	8	30	0	60	30	25	36	30	50
68	F	6	40	20	80	40	4	15	21	33
55	F	8	30	10	60	30	24	37	30	46
59	M	10	30	20	50	40	30	40	30	42
43	F	1	50	20	80	50	16	20	28	38

Abbreviations: F, female; M, male; VAS, visual analog scale.

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