{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:23:24Z","timestamp":1789039404913,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Spasticity of the upper extremity can result in severe pain, along with many complications that can impair a patient\u2019s activities of daily living. Failure to treat patients with spasticity of the upper limb can result in a decrease in the range of motion of joints and contracture development, leading to further restriction in daily activities. We aimed to investigate the practice patterns of Canadian physicians who utilize Botulinum toxin type-A (BoNT-A) injections in the management of shoulder spasticity. 50 Canadian Physical Medicine and Rehabilitation (PM&amp;R) physicians completed a survey with an estimated completion rate of (36.23%). The demographics of the survey participants came from a variety of provinces, clinical settings, and patient populations. The most common muscle injected for shoulder adduction and internal rotation spasticity was the pectoralis major, this was followed by latissimus dorsi, pectoralis minor, subscapularis and teres major. Injection of BoNT-A for problematic post-stroke shoulder spasticity was common, with (81.48%) of participants responding that it was always or often used in their management of post-stroke spasticity (PSS). Dosing of BoNT-A demonstrated variability for the muscle injected as well as the type of toxin used. The goals of the patients, caregivers, and practitioners were used to help guide the management of these patients. As a result, the practice patterns of Canadian physicians who treat shoulder spasticity are varied, due to numerous patient factors. Future studies are needed to analyze optimal treatment patterns, and the development of algorithms to standardize care.<\/jats:p>","DOI":"10.3390\/toxins15010058","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T01:57:48Z","timestamp":1673315868000},"page":"58","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Canadian Physicians\u2019 Use of Intramuscular Botulinum Toxin Injections for Shoulder Spasticity: A National Cross-Sectional Survey"],"prefix":"10.3390","volume":"15","author":[{"given":"Farris","family":"Kassam","sequence":"first","affiliation":[{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan","family":"Lim","sequence":"additional","affiliation":[{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadia","family":"Afroz","sequence":"additional","affiliation":[{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5994-2903","authenticated-orcid":false,"given":"\u00c8ve","family":"Boissonnault","sequence":"additional","affiliation":[{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada"},{"name":"Division of Physical Medicine and Rehabilitation, Universit\u00e9 de Montr\u00e9al, Montreal, QC H3S 2J4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Reebye","sequence":"additional","affiliation":[{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada"},{"name":"Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada"},{"name":"GF Strong Rehabilitation Center, Vancouver, BC V5Z 2G9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Finlayson","sequence":"additional","affiliation":[{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada"},{"name":"Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada"},{"name":"GF Strong Rehabilitation Center, Vancouver, BC V5Z 2G9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8403-6988","authenticated-orcid":false,"given":"Paul","family":"Winston","sequence":"additional","affiliation":[{"name":"Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z7, Canada"},{"name":"Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 2G9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/09638280400014576","article-title":"Spasticity: Clinical perceptions, neurological realities and meaningful measurement","volume":"27","author":"Pandyan","year":"2005","journal-title":"Disabil. 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