Analysis of a 15-years’ experience in including shoulder muscles, when treating upper-limb spasticity post-stroke with botulinum toxin type A

Abstract

Background

Botulinum toxin type-A (BoNTA) is a recognized treatment for upper limb spasticity (ULS) after stroke, but there aren’t many studies analyzing its effect in shoulder muscles.

Objective

To evaluate the efficacy of BoNTA injections for ULS, when shoulder muscles are included.

Methods

A cross-sectional study. Data from clinical forms of outpatients, treated at a Rehabilitation Center (2001–2016). Analyzes: goals of treatment; demographic characteristics/goal; treatment success, using Goal Attainment Scaling.

Results

Eighty-six stroke-patients, submitted to 547 BoNTA treatment sessions. The most injected shoulder muscles were subscapularis (SC) 35%, pectoralis major (PM) 31%, deltoideus 14%. The most selected goals for treatment were: involuntary movements (IM) 33%, pain/discomfort (PD) 26%, and mobility (MOB) 18%. Patients achieved or overachieved the IM goal in 76%, PD in 78%, and MOB in 79%. Patients with IM goal were younger (p < 0.01), than those setting other goal types; PD patients, were older (p < 0.019), treated half a year earlier (p < 0.01), and had more spasticity (MAS ≠ 0.15); MOB patients were younger (p = 0.04) and less spastic (MAS ≠ 0.12). Achieving PD goal impacted positively in improving MOB (p = 0.042) and passive function (p = 0.018).

Conclusion

When treating ULS, including shoulder muscles, the most frequent goals were IM, PD e MOB. The most injected muscles were SC and PM. The treatment was successful in a large percentage of cases. Achieving the PD goal was associated with greater success at other goals of treatment. BoNTA demonstrated a positive effect in controlling symptoms and improving function.

Keywords:

• Stroke
• upper limb spasticity
• botulinum toxin type-A
• hemiplegic shoulder
• shoulder muscles
• treatment efficacy