Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using a ultrasound-guided approach

Abstract

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). 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.