We describe two cases of a syndrome resembling neuralgic amyotrophy th
at occurred in limbs injected with botulinum toxin for writer's cramp.
In both cases, one of the injections was followed by pain and the nex
t, 7-10 weeks later, by weakness. We believe that unexplained pain in
the shoulder region after an injection of botulinum toxin contraindica
tes a second injection.