A Botox jab to soothe your sore shoulder

BOTOX jabs are now being used to relieve the pain of shoulder arthritis. British surgeons are injecting the toxin, loved by celebrities and millions of Britons for its ability to reduce lines in the face, into the shoulders of patients with rotator cuff arthropathy.

Some even report being painfree after just a single jab.

The rotator cuff is a group of four muscles and four tendons that surround the joint. They keep the head of the upper arm bone, the humerus, inside the shallow shoulder socket.

Although the cuff can be damaged by injury, most cases of rotator cuff arthropathy are the result of joint degeneration due to advancing age. It affects up to one in four people at some point in their lives, usually after the age of 50.

As we age, the blood supply to the tendons reduces and they become weaker. This can result in part of the shoulder blade rubbing against the tendons, leading to tears in the tissue and loss of full movement. Even raising an arm above the head can become impossible.

A study by orthopaedic surgeons at the University of Saarland Medical School in Germany found that 13 per cent of people in their 50s have evidence of tears, rising to 51 per cent of people in their 80s.

Initial treatment can include ice or heat packs, physiotherapy and anti- inflammatory drugs. But if the damage, or arthritis of the shoulder, is advanced, surgery may be an option.

Botox is usually associated with cosmetic surgery for reducing the appearance of frown lines and wrinkles, but it is used increasingly in medicine for a variety of conditions.

When Botox is injected into muscles, the toxin blocks the nerve signals that cause the tightening of muscle, leading to the tissue relaxing.

Chris Smith, a consultant shoulder and elbow surgeon at the Royal Devon and Exeter Hospital, has been using Botox to treat patients with rotator cuff arthropathy. They are given a single jab into the supraspinatus muscle attached to the torn tendon. The patient then undergoes physiotherapy to mobilise the shoulder.

‘ Rotator cuff tears are very common, especially after the age of 60,’ he says. ‘This is usually caused by wear and tear, and one theory is that evolution has not caught up with our change in use of the shoulders since the time we used to walk on all fours.

‘ We now use our arms for a number of tasks above head height, which puts the tendon at risk of damage.

‘ Although rotator cuff tears are common, not all patients have symptoms and it’s not clear why. One theory is that there is no pain when the tendon is completely torn because it is no longer attached to the bone.

‘It may be that when the tear is only partial, the pain occurs because there is increased strain on t he t endon t hat remains attached to the bone.

‘ Injecting Botox stops that muscle from moving. As it is unable to contract, it is hoped that this removes the strain from any remaining partially torn tendon.’

Mr Smith has treated eight patients so far and describes the results as encouraging.

He says: ‘If we find high levels of pain relief with the injections, then patients could avoid the need for surgery.

‘It would also lead to significant NHS savings because this treatment is 50 times cheaper than a joint replacement.’