Thoracic Outlet Syndrome Treated With Injecting Botulinum Toxin Into Middle Scalene Muscle and Pectoral Muscle...

Area of Science:

• Pain Management
• Neurology
• Musculoskeletal Disorders

Background:

• Thoracic outlet compression syndrome (TOS) involves neurovascular compression at the superior thoracic aperture.
• TOS can occur in three distinct anatomical compartments: the interscalene triangle, costoclavicular space, and retropectoralis minor space.

Observation:

• A 44-year-old woman with TOS experienced treatment failure with conservative therapies, including physical therapy.
• The patient declined surgical intervention for her condition.

Findings:

• Injections into the middle interscalene muscle (ISM) and pectoralis muscle plane (PECS I and II) are increasingly utilized for TOS symptom relief.
• Successful treatment was achieved using ISM and PECS I/II blocks with botulinum toxin type A in the observed patient.
• Combined PECS I/II and ISM injections demonstrated excellent symptomatic relief.

Implications:

• Botulinum toxin injections represent a viable alternative for patients with TOS who are not candidates for or decline surgery.
• This minimally invasive approach offers significant symptomatic improvement for refractory TOS cases.
• Targeted muscle injections provide a promising therapeutic strategy for managing TOS.