Stiff Shoulders / Botulinum Toxin

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Botulinum toxin injection for stiff shoulders

Around the neck and shoulders, there are various muscles that are constantly under tension, supporting the weight of the head and arms. When this tension persists, the muscles become tired and stiff. This can lead to pressure on blood vessels, impairing blood flow, and potentially causing damage to peripheral nerves, resulting in shoulder stiffness and pain.

Injecting Botulinum Toxin into the shoulder muscles allows the tense, rigid muscles to relax and become more pliable. By improving the stiffness, blood circulation is enhanced, preventing the buildup of fatigue-inducing substances and providing relief from troublesome shoulder stiffness and pain.

Furthermore, easing the tension in the trapezius muscle creates a graceful line from the shoulders to the neck.

Recommended for：

Those experiencing tension and stiffness in the shoulder muscles, struggling with shoulder pain.
Those looking to achieve a slim and graceful shoulder line.

Flow of treatment

The actual treatment process is as follows. For more information on the formulation and needles used, see the Botulinum toxin treatment page.

STEP

Examination / injections / records

We will perform a touch examination to identify the location and depth of tension. Botulinum toxin (Coretox) will be injected into approximately 20 points along the trapezius muscle, which extends from the neck to the shoulders.

All information regarding injection sites, depth, and units will be documented in your medical record along with photos, ensuring a safe and consistent treatment experience for subsequent sessions.

Please note that there may also be tension in muscles such as the levator scapulae or the rhomboids. However, due to potential side effects like difficulty raising the arm, we will focus on treating the trapezius muscle in the initial session.

STEP

After treatment

When inserting a needle into the muscle, there may be a dull pain that persists for about two weeks. Symptoms like fatigue and difficulty exerting force may occur, but these typically improve within 2 to 3 weeks.

▢ Aiming to slim your shoulders: The muscle in the trapezius area that was injected will become smaller after about a month. Since one injection may not provide sufficient results, it is recommended to undergo the procedure again approximately every 6 months.
▢ Aiming to improve stiff shoulders: Injections are administered every 3 to 4 months. Incorporating exercises like stretching while the muscles are still relaxed can help prolong the effects and make it less likely for the condition to return. From the second session onward, it’s perfectly fine to receive injections only when you feel the tension again.

Side effects and precautions

For information on side effects and post-treatment precautions, see Potential side effects of botulinum toxin injections.

Price for stiff shoulders treatment with botulinum toxin injection

At our clinic, we use “Coretox” as a botulinum toxin preparation.

Item	Fee (tax included)
Consultation fee	First visit ¥3,850 Revisit ¥1,650
Stiff shoulders 50-unit Stiff shoulders 100-unit Stiff shoulders 150-unit	¥29,700 ¥44,000 ¥58,300

Each injection requires a consultation every time. Please be aware that a separate consultation fee will apply.

Frequently Asked Questions About Botulinum Toxin Injections for Stiff Shoulders

For general inquiries about Botulinum Toxin injections and post-injection questions, please refer to the “Frequently Asked Questions about Botulinum Toxin Injections.”

How painful is the injection?

You may experience a dull pain when injecting into tense muscles, but since an extremely fine needle is used, it does not typically require anesthesia for pain relief.

Which is better, Botox or Coretox?

For stiff shoulders treatment, we recommend Coretox because it is less likely to develop resistance (antibodies) since higher injection amounts are required.

How many units do you recommend for the injection?

We typically recommend 100 units for each shoulder.

If you are smaller and have less muscle mass, you may choose 50 units. For individuals with larger muscle mass, 150 units is an option.

How soon can I feel the effects?

Your shoulders will start to feel lighter after a few days at the earliest or two weeks at the latest. For the first two weeks, you may experience some muscle soreness from the injections.

My shoulders feel sore after the injection.

Due to the effects of the needles, you may experience temporary shoulder pain or malaise. It usually improves in 2 to 3 weeks.

Can I inject it for stiff neck?

From the neck to the shoulders, muscles such as the cervical splenius muscle and the splenius capitis muscle run. Botulinum toxin injections may cause the muscles to relax too much and affect the muscles that support the neck, so treatment may not be possible.

Is it possible to experience a decreased ability to exert force?

The area where the Botulinum Toxin injection is administered may experience muscle relaxation, making it more difficult to exert strength. This typically doesn’t interfere with day-to-day light activities, but there may be an impact when lifting heavy objects, for example.

Can I massage or exercise after the injection?

There are no restrictions unless you rub it hard or exercise vigorously.

Muscles are relaxed due to the botulinum toxin injection, and shoulder stiffness may be further improved by massaging and stretching the shoulders.

List of references/websites

Nicol AL, Wu II, Ferrante FM. Botulinum toxin type a injections for cervical and shoulder girdle myofascial pain using an enriched protocol design. Anesth Analg. 2014 Jun;118(6):1326-35. doi: 10.1213/ANE.0000000000000192. PMID: 24842179; PMCID: PMC4030686.
Sáenz A, Avellanet M, Garreta R. Use of botulinum toxin type A on orthopedics: a case report. Arch Phys Med Rehabil. 2003 Jul;84(7):1085-6. doi: 10.1016/s0003-9993(03)00044-3. PMID: 12881840.
Hsu PC, Wu WT, Han DS, Chang KV. Comparative Effectiveness of Botulinum Toxin Injection for Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials. Toxins (Basel). 2020 Apr 12;12(4):251. doi: 10.3390/toxins12040251. PMID: 32290577; PMCID: PMC7232231.
Zhou JY, Wang D. An update on botulinum toxin A injections of trigger points for myofascial pain. Curr Pain Headache Rep. 2014 Jan;18(1):386. doi: 10.1007/s11916-013-0386-z. PMID: 24338700.
Benecke R, Heinze A, Reichel G, Hefter H, Göbel H; Dysport myofascial pain study group. Botulinum type A toxin complex for the relief of upper back myofascial pain syndrome: how do fixed-location injections compare with trigger point-focused injections? Pain Med. 2011 Nov;12(11):1607-14. doi: 10.1111/j.1526-4637.2011.01163.x. Epub 2011 Jun 21. PMID: 21692970.
Ferrante FM, Bearn L, Rothrock R, King L. Evidence against trigger point injection technique for the treatment of cervicothoracic myofascial pain with botulinum toxin type A. Anesthesiology. 2005 Aug;103(2):377-83. doi: 10.1097/00000542-200508000-00021. PMID: 16052120.
Kim DY, Kim JM. Safety and Efficacy of PrabotulinumtoxinA (Nabota®) Injection for Cervical and Shoulder Girdle Myofascial Pain Syndrome: A Pilot Study. Toxins (Basel). 2018 Sep 3;10(9):355. doi: 10.3390/toxins10090355. PMID: 30177597; PMCID: PMC6162536.