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Related Experiment Video

Updated: Jan 8, 2026

Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft
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A Novel Patient-Specific Landmark-Guided Approach for Intramuscular Botulinum Neurotoxin Injections Into the Rotator

Dave Osinachukwu Duru1,2, David Kwan Ryung Lee1,2, Gavin E Jarvis3

  • 1Human Anatomy Centre, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.

Clinical Anatomy (New York, N.Y.)
|December 23, 2025
PubMed
Summary

This study introduces a new patient-specific technique for delivering botulinum neurotoxin (BoNT) to rotator cuff muscles, improving accessibility for treating chronic shoulder pain caused by myofascial pain syndrome.

Keywords:
botulinum neurotoxin (BoNT)cadavericinjectionlandmark‐guidedmotor pointsmyofascial painpatient‐specificrotator cuffsuprascapular nervevariation

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Area of Science:

  • Anatomy
  • Pain Management
  • Neurology

Background:

  • Myofascial pain syndrome (MFPS) frequently causes chronic shoulder pain, often involving the supraspinatus and infraspinatus rotator cuff muscles.
  • Intramuscular botulinum neurotoxin (BoNT) injections targeting motor points are effective for MFPS pain, but current delivery methods face accessibility challenges.

Purpose of the Study:

  • To develop and validate a patient-specific, landmark-guided technique for BoNT delivery into the supraspinatus and infraspinatus muscles using scapular dimensions.

Main Methods:

  • Cadaveric shoulder dissections (n=20) identified motor points of the supraspinatus and infraspinatus.
  • Distances from scapular landmarks to motor points were measured and correlated with scapular dimensions via linear regression to derive predictive formulae.
  • Validation involved landmark-guided methylene blue injections on four cadaveric shoulders using calculated coordinates.

Main Results:

  • Predictive formulae for supraspinatus motor points utilized the deltoid tubercle and root of the scapular spine (r=0.58-0.64, p=0.0016-0.021).
  • Predictive formulae for infraspinatus motor points used the root of the scapular spine and lateral acromion (r=0.46-0.60, p=0.0054-0.0500).
  • All validation injections accurately reached the target motor points.

Conclusions:

  • A validated, patient-specific, landmark-guided technique for BoNT delivery to the rotator cuff muscles was established.
  • This novel approach enhances the accessibility of BoNT injections for managing chronic shoulder pain and improving analgesia.