Intra-Articular Injection of Botulinum Toxin Type A for Shoulder Pain

Inclusion Criteria: * • Male or female subjects, 18 years of age or older. * Written informed consent and written authorization for use or release of health and research study information have been obtained. * Subject has chronic Shoulder joint pain for more than 1 year. * Subject has pain \>4.5 on numerical rating scale of 0 to 10. * Ability to follow study instructions and likely to complete all required visits. * Negative urine pregnancy test on the day of treatment prior to the administration of study medication (for females of childbearing potential if applicable) * Patients previously treated with intra-articular corticosteroid or viscosupplementation injections. * Patients with rheumatoid arthritis must have failed therapy with standard DMARDs (disease modifying anti-rheumatic drugs) and anti-TNF agents unless they have a contraindication to TNF blockers. * Patients who were considered not to be candidates for Shoulder joint replacement because of young age, abnormalities in periarticular tissues or because of co-morbid conditions. * Must be ambulatory and able to perform sit to stand. Exclusion Criteria: * Use of aminoglycoside antibiotics, curare-like agents, or other agents that might interfere with neuromuscular function. * Any medical condition that may put the subject at increased risk with exposure to botulinum neurotoxin including diagnosed myasthenia gravis, Eaton-Lambert syndrome, amytrophic lateral sclerosis, any other disorder that might interfere with neuromuscular function or the presence of severe peripheral neuropathy. * Females who are pregnant, breast-feeding, or planning a pregnancy during the study or who think that they may be pregnant at the start of the study, or females of childbearing potential who are unable or unwilling to use a reliable form of contraception during the study. * Known allergy or sensitivity to any of the components in the study medication. * Evidence of recent alcohol or drug abuse. * Infection at injection site or systemic infection (postpone study entry until one week following recovery. * Known, uncontrolled serious systemic disease and/or life expectancy less than 12 months. * Concurrent participation in another investigational drug or device study or participation in the 30 days immediately prior to study enrollment. * Any condition or situation that, in the investigator's opinion, may put the subject at significant risk, confound the study results, or interfere significantly with the subject's participation in the study. * Patients whose pain is rated as less than 4.5 on a 10 point Numerical Pain Rating scale at the screening visit * Patients on coumadin or heparin because of increased risk of bleeding in the joint * Serious or unstable psychiatric disease or cognitive impairment that would limit evaluation of response to treatment.