APSP J Case Rep: Vol. 4 Issue 3: p. 46
Copyright © 2013 Lemon
Received Day: 06 Month: 07 Year: 2013
Accepted Day: 02 Month: 09 Year: 2013
APSP J Case Rep 2013; 4(3):46
Use of Botox Injection As a Bridge In Pediatric Recurrent Shoulder Dislocations
Thomas I Lemon Affiliation: School of Medicine Cardiff University
Correspondence: Address for Correspondence:Thomas I Lemon, School of Medicine Cardiff University, [email protected]

Dear Sir,

Recurrent gleno-humeral dislocation is not a limb threatening condition but results in great distress in adolescent patients.[1] This may potentially lead to psychiatric and long term physical disability. Due to the rarity of this condition in children, the management is not always known. Herein, we present a perhaps unorthodox but successful management of this condition as measured by reduced intensity of pain and decrease in frequency of recurrent gleno-humeral dislocations before definitive treatment could be offered.

A 16-year-old boy, who had a bicycle accident 4 years ago, suffered on-going recurrent dislocations of his left shoulder. The shoulder used to dislocate more than 10 times a day, and resulted in regular visits to Accident and Emergency Department. Previously the shoulder was normal. Aetiology of the recurrent dislocations was unclear. Imaging (Plain film X-ray and later Magnetic Resonance Imaging) of the shoulder was unremarkable. The dislocations affected greatly his daily chores. On examination, the patient was able to dislocate shoulder voluntarily in clinic – showing loss of normal shoulder contour. There was no noticeable inflammation or muscle wasting. Whilst dislocated, the pectoralis major was overtly in spasm. On palpitation, the sterno-clavicular and acromio-clavicular joints were found normal bilaterally. The acromion and coracoid processes, scapula, spine, and biceps tendon in the biciptal groove were also normal on both the sides. No tenderness of the supraspinatus tendon was present. All movements were noticeably reduced when shoulder dislocated. Patient was given inj. botox to the pectoralis major. A reduction in the severity of pain and frequency of dislocations with the first injection was noted afterwards. He is currently on repeated inj. botox therapy.

There are three types of shoulder dislocations. Anterior dislocation (95%) which is commonly sub-coracoid; it has potential to damage axillary artery. Posterior dislocation may be caused by seizures or strength imbalance of rotator cuff muscles; it is often undetected. Inferior dislocation (0.8%) also called luxation erecta.[1-5] Our case does not fit into any of these types. The pectoralis major seems to be in spasm when dislocation occurs, and the inj. botox ceases this. The plan to give repeated inj. botox to the lower part of pectoralis major lessened the severity of pain and frequency of dislocations. This has dramatically improved his daily activities. Inj. botox administration could be considered in recurrent post traumatic gleno-humeral dislocations awaiting surgical interventions, other skeletal muscle spasm (particularly oculomotor and facial spasm) and pain control (ranging from chronic pain to post haemorrhoidectomy pain).[2-5] It is important to note that long term psychiatric problems can occur in paediatric patients owing to long standing pain; inj. botox proved to be a temporary way-forward in our patient until a definite diagnosis and treatment are instituted.


Source of Support: Nil

Conflict of Interest: None declared

1. Bishop J, Flatow E. Pediatric shoulder trauma. Clin Orthop Relat Res. 2005;43:41-8.
2. Okumus S, Coskun E, Erbagci I, Tatar MG, Comez A, Kaydu E, et al. Botulinum toxin injections for blepharospasm prior to ocular surgeries. Clin Ophthalmol. 2012;6:579-83.
3. Van Beek AL, Lim PK, Gear AJ, Pritzker MR. Management of vasospastic disorders with botulinum toxin A. Plast Reconstr Surg. 2007;119:217-26
4. Davies J, Duffy D, Boyt N, Aghahoseini A, Alexander D, Leveson S. Botulinum toxin (botox) reduces pain after hemorrhoidectomy: results of a double-blind, randomized study. Dis Colon Rectum. 2003;46:1097-102.
5. Lawton RL, Choudhury S, Mansat P, Cofield RH, Stans AA. Pediatric shoulder instability: presentation, findings, treatment, and outcomes. J Pediatr Orthop. 2002;22:52-61.


  • There are currently no refbacks.

Copyright (c) 2013 APSP Journal of Case Reports

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN: 2218-8185

We are now in process to use new version of Open Journal System. Submission are now open on our new website. Please CLICK HERE to divert to our new manuscript management system. You are required to register an author account before making any submission.