{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:33:21Z","timestamp":1760060001992,"version":"build-2065373602"},"reference-count":58,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Merz"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>There is limited published guidance available to help less experienced practitioners assess and manage shoulder conditions, including spasticity, after acquired central nervous system (CNS) lesions. To address this gap, 11 spasticity and dystonia experts convened in a 2023 meeting to build on existing guidance, provide consensus on best treatment practice, and develop expert recommendations to guide the diagnosis and treatment of complications of shoulder conditions following CNS lesions. Presentations by each expert on diagnosis and management were followed by discussion; consensus on assessment and treatment practices was identified and recommendations developed. The expert panel recommended an assessment approach structured using the following components: patient history, including interpretation of reported symptoms; observation of postures and pain responses; clinical examination with targeted tests for specific signs; diagnostic tests; and assessment of upper limb impairment, activity limitations, and participation restrictions. This assessment process and the recommended measures recognize the importance of identifying shoulder involvement in upper limb spasticity as part of the diagnostic process in shoulder conditions following CNS lesions. These recommendations provide a practical approach to diagnosis and treatment for clinicians who are less experienced in evaluating and treating such conditions, simplifying otherwise complicated clinical scenarios.<\/jats:p>","DOI":"10.3390\/toxins17080385","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T15:30:06Z","timestamp":1754321406000},"page":"385","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pathways for Diagnosis and Multimodal Management, Including Botulinum Neurotoxin Therapy, in Shoulder Conditions Following Acquired Central Nervous System Lesions"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7682-1353","authenticated-orcid":false,"given":"Bo","family":"Biering-S\u00f8rensen","sequence":"first","affiliation":[{"name":"Rigshospitalet, Neurological Department, Movement Disorder and Pain Research Center, 2600 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Cordero-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Hospital Universitario Juan Ram\u00f3n Jim\u00e9nez, 21005 Huelva, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Boulias","sequence":"additional","affiliation":[{"name":"West Park Healthcare Centre, Toronto, ON M6M 2J5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damon","family":"Hoad","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick, Warwick CV4 7AL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Djamel","family":"Bensmail","sequence":"additional","affiliation":[{"name":"Raymond-Poincar\u00e9 Hospital, GH Universit\u00e9 Paris Saclay, University of Versailles Saint-Quentin-en-Yvelines, 92380 Garches, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franco","family":"Molteni","sequence":"additional","affiliation":[{"name":"Villa Beretta Rehabilitation Center, 23845 Costa Masnaga, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9732-7410","authenticated-orcid":false,"given":"Fran\u00e7ois","family":"Gen\u00eat","sequence":"additional","affiliation":[{"name":"Raymond-Poincar\u00e9 Hospital, GH Universit\u00e9 Paris Saclay, University of Versailles Saint-Quentin-en-Yvelines, 92380 Garches, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6238-3578","authenticated-orcid":false,"given":"J\u00f6rg","family":"Wissel","sequence":"additional","affiliation":[{"name":"Neurology and Psychosomatic at Wittenbergplatz, 10787, Berlin and University of Potsdam, 14469 Potsdam, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3428-2312","authenticated-orcid":false,"given":"Jorge","family":"Jacinto","sequence":"additional","affiliation":[{"name":"Centro de Medicina de Reabilita\u00e7\u00e3o de Alcoit\u00e3o, 2649-506 Alcabideche, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Marque","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Purpan, 31059 Toulouse, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steffen","family":"Berweck","sequence":"additional","affiliation":[{"name":"Ludwig-Maximilians-University of Munich, 80539 Munich, Germany"},{"name":"Sch\u00f6n Klinik Vogtareuth, 83569 Vogtareuth, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Jacinto, J., Cam\u00f5es-Barbosa, A., Carda, S., Hoad, D., and Wissel, J. 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