Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using a ultrasound-guided approach
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The purpose of this study was to describe the technique, complications, and rate of symptom relief after ultrasound-guided botulinum toxin injection in subjects with suspected neurogenic thoracic outlet syndrome (NTOS).
Materials and Methods
This study was IRB-approved and followed HIPPA guidelines. Subjects investigated for NTOS were identified via retrospective review of medical records. Procedures included botulinum toxin injections of the anterior scalene, pectoralis minor, and subclavius muscles performed under real-time ultrasound guidance. Technical success was defined as satisfactory muscle identification, intramuscular needle placement, and intramuscular delivery of medication. Follow-up was performed to determine procedure-related complications and therapy response using a binary assessment and modified visual analogue scale (VAS).
Forty-one subjects with suspected NTOS underwent a total of 92 injections (58 anterior scalene, 33 pectoralis minor, and 1 subclavius muscle). Technical success was achieved in all procedures. No complications occurred. Symptom improvement occurred after 69% of procedures. The VAS before and after the procedure changed from 7.1 to 2.8 (P < 0.0001) respectively. The mean time to symptom improvement and duration of symptom improvement were 12 and 31 days respectively.
Botulinum toxin injection under ultrasound guidance is a safe and well-tolerated procedure with a satisfactory rate of temporary symptom relief in subjects with suspected NTOS.
- Demondion X, Herbinet P, Van Sint Jan S, Boutry N, Chantelot C, Cotten A. Imaging assessment of thoracic outlet syndrome. Radiographics. 2006;26:1735–50. CrossRef
- Sanders RJ, Hammond SL, Rao NM. Thoracic outlet syndrome: a review. Neurologist. 2008;14:365–73. CrossRef
- Jordan SE, Ahn SS, Freischlag JA, Gelabert HA, Machleder HI. Selective botulinum chemodenervation of the scalene muscles for treatment of neurogenic thoracic outlet syndrome. Ann Vasc Surg. 2000;14:365–9. CrossRef
- Jordan SE, Ahn SS, Gelabert HA. Combining ultrasonography and electromyography for botulinum chemodenervation treatment of thoracic outlet syndrome: comparison with fluoroscopy and electromyography guidance. Pain Physician. 2007;10:541–6.
- Jordan SE, Machleder HI. Diagnosis of thoracic outlet syndrome using electrophysiologically guided anterior scalene blocks. Ann Vasc Surg. 1998;12:260–4. CrossRef
- Braun RM, Sahadevan DC, Feinstein J. Confirmatory needle placement technique for scalene muscle block in the diagnosis of thoracic outlet syndrome. Tech Hand Up Extrem Surg. 2006;10:173–6. CrossRef
- Lee IH, Yoon YC, Sung DH, Kwon JW, Jung JY. Initial experience with imaging-guided intramuscular botulinum toxin injection in patients with idiopathic cervical dystonia. AJR Am J Roentgenol. 2009;192:996–1001. CrossRef
- Torriani M, Gupta R, Donahue DM. Sonographically guided anesthetic injection of anterior scalene muscle for investigation of neurogenic thoracic outlet syndrome. Skeletal Radiol. 2009;38:1083–7. CrossRef
- Seyler TM, Smith BP, Marker DR, et al. Botulinum neurotoxin as a therapeutic modality in orthopaedic surgery: more than twenty years of experience. J Bone Jt Surg Am. 2008;90 (Suppl 4):133–45. CrossRef
- Odergren T, Hjaltason H, Kaakkola S, et al. A double blind, randomised, parallel group study to investigate the dose equivalence of Dysport and Botox in the treatment of cervical dystonia. J Neurol Neurosurg Psychiatry. 1998;64:6–12. CrossRef
- Aoki KR. Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology. 2005;26:785–93. CrossRef
- Favre-Guilmard C, Auguet M, Chabrier PE. Different antinociceptive effects of botulinum toxin type A in inflammatory and peripheral polyneuropathic rat models. Eur J Pharmacol. 2009;617:48–53. CrossRef
- Yuan RY, Sheu JJ, Yu JM, et al. Botulinum toxin for diabetic neuropathic pain: a randomized double-blind crossover trial. Neurology. 2009;72:1473–8. CrossRef
- Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using a ultrasound-guided approach
Volume 39, Issue 10 , pp 973-980
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- Neurogenic thoracic outlet syndrome
- Botulinum toxin
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- Author Affiliations
- 1. Division of Musculoskeletal Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
- 4. Musculoskeletal Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street-YAW 6048, Boston, MA, 02114, USA
- 2. Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
- 3. Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA