Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-24T07:57:35.934Z Has data issue: false hasContentIssue false

Chapter 36 - Ultrasound-Guided Botulinum Toxin Injections for Thoracic Outlet Syndrome

Published online by Cambridge University Press:  02 November 2023

By
Michael E. Farrell  and
Katharine E. Alter
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
Get access

Summary

Thoracic outlet syndrome (TOS) is a rare, often perplexing disorder caused by compression of neurovascular structures, just above the first rib and behind the clavicle or under the pectoralis minor, leading to cervicogenic–brachial pain and other symptoms in neck and upper limb. This chapter reviews the subtypes of TOS, such as neurogenic and vasogenic, illustrates the anatomy of the thoracic outlet and discusses the common sites of nerve entrapment.

Botulinum neurotoxin (BoNT) is an emerging treatment for TOS. Intramuscular injection of BoNT reduces muscle spasm and produces denervation atrophy of hypertrophied muscles, relieving compression of neurovascular structures and ameliorating both neurogenic and vasogenic symptoms. Risks associated with injection and the BoNT itself make guidance and targeting techniques important. Therefore, ultrasound (US) guidance for accurate injection placement is stressed. This chapter will briefly review TOS and the literature related to use of BoNT for TOS and also provide a detailed review of procedural techniques for US guidance.

Keywords

Thoracic outlet syndromeTOScervical rib syndromeneurogenic thoracic outlet syndromearterial vasogenic thoracic outlet syndromeBoNT
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 299 - 310
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alter, KE (2010). High-frequency US guidance for neurotoxin injections. Phys Med Rehabil Clin N Am, 21, 607–30.CrossRefGoogle Scholar
Alter, KE, Hallett, M, Karp, B, Lungu, C (2020). US Guided Chemodenervation Procedures. Text and Atlas. New York: Demos Medical, pp. 108–23.Google Scholar
Aoki, KR (2005). Review of proposed mechanism for the antinociceptive action of botulism toxin type A. Neurotoxicology, 6, 785–93.Google Scholar
Barwood, S, Baillieu, C, Boyd, R et al. (2000). Analgesic effects of botulinum toxin A: a randomized, placebo-controlled clinical trial. Dev Med Child Neurol, 42, 116–21.Google Scholar
Benzon, HT, Rodes, ME, Chekka, K et al. (2012). Scalene muscle injections for neurogenic thoracic outlet syndrome: case series. Pain Pract, 12, 66–70.Google Scholar
Brooke, BS, Freischlag, JA (2010). Contemporary management of thoracic outlet syndrome. Curr Opin Cardiol, 25, 535–40. https://doi.org.10.1097/HCO.0b013e32833f028eCrossRefGoogle ScholarPubMed
Cavallieri, F, Galletti, S, Fioravanti, V et al. (2021). Botulinum toxin treatment for thoracic outlet syndrome induced by subclavius muscle hypertrophy. NeuroSci, 2, 135–40.CrossRefGoogle Scholar
Danielson, K, Odderson, IR (2008). Botulinum toxin type A improves blood flow in vascular thoracic outlet syndrome. Am J Phys Med Rehabil, 87, 956–9.CrossRefGoogle ScholarPubMed
Donahue, DM, Godoy, IRB, Gupta, R, Donahue, JA, Torriani, M (2020). Sonographically guided botulinum toxin injections in patients with neurogenic thoracic outlet syndrome: correlation with surgical outcomes. Skeletal Radiol,. 49, 715–22. https://doi.org/10.1007/s00256-019-03331-9CrossRefGoogle ScholarPubMed
Falconer, MA, Weddell, G (1943). Costoclavicular compression of the subclavian artery and vein. Lancet, 2, 539.CrossRefGoogle Scholar
Farrell, M, Karp, BI, Kassavetis, P et al. (2020). Management of anterocapitis and anterocollis: a novel ultrasound guided approach combined with electromyography for botulinum toxin injection of longus colli and longus capitis. Toxins (Basel), 12, 626. https://doi.org/10.3390/toxins12100626CrossRefGoogle ScholarPubMed
Ferrante, MA (2012). The thoracic outlet syndromes. Muscle Nerve, 45, 780–95.CrossRefGoogle ScholarPubMed
Finlayson, HC, O’Connor, RJ, Brasher, PMA, Travlos, A (2011). Botulinum toxin injection for management of thoracic outlet syndrome: a double-blind, randomized, controlled trial. Pain, 152 , 2023–8. https://doi.org/10.1016/j.pain.2011.04.027CrossRefGoogle ScholarPubMed
Foley, JM, Finlayson, H, Travlos, A (2012). A review of thoracic outlet syndrome and the possible role of botulinum toxin in the treatment of thoracic outlet syndrome. Toxins, 4, 1223–35.Google Scholar
Gobel, H, Heinze, A, Reichel, G (2006). Efficacy and safety of a single botulinum type A toxin complex treatment for the relief of upper back myofascial pain syndrome: results from a randomized double-blind placebo controlled multicentre study. Pain, 125, 82–8.CrossRefGoogle ScholarPubMed
Gross, RA, Johnston, KC (2009). Levels of evidence: taking neurology to the next level. Neurology, 72 , 8–10. https://doi.org/10.1212/01.wnl00000342200.58823.6aCrossRefGoogle Scholar
Hong, JS, Sathe, GG, Niyonkuru, C et al. (2012). Elimination of dysphagia using US guidance for botulinum toxin injections in cervical dystonia. Muscle Nerve, 46, 535–9.CrossRefGoogle ScholarPubMed
Illig, KA, Donahue, D, Duncan, A et al. (2016). Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg, 64 , e23–35. https://doi.org/10.1016/j.jvs.2016.04.039CrossRefGoogle Scholar
Jordan, SE, Ahn, SS, Freischlag, JA, Gelabert, HA, Machleder, HI (2000). Selective botulinum chemodenervation of the scalene muscles for treatment of neurogenic thoracic outlet syndrome. Ann Vasc Surg, 14, 365–9. https://doi.org/10.1007/s100169910079Google Scholar
Jordan, SE, Ahn, SS, Gelabert, HA, Danielson, K, Odderson, IR (2007). Combining ultrasonography and electromyography for botulinum chemodenervation treatment of thoracic outlet syndrome: comparison with fluoroscopy and electromyography guidance. Pain Physician, 10, 541–6.Google ScholarPubMed
Le, EN, Freischlag, JA, Christo, PJ et al. (2010). Thoracic outlet syndrome secondary to localized scleroderma treated with botulinum toxin injection. Arthritis Care Res, 62, 430–3.CrossRefGoogle ScholarPubMed
Mense, S (2004). Neurobiological basis for the use of botulinum toxin in pain therapy. Neurology, 251, 11–17.Google Scholar
Murphy, JB (1916). Cervical rib excision: collective review on surgery of cervical rib. Clin John B Murphy, 5, 227.Google Scholar
Ochsner, A, Gage, M, DeBakey, M (1935). Scalenus anticus (Naffziger) syndrome. Am J Surg, 28, 669–77.CrossRefGoogle Scholar
Odderson, IR, Chun, ES, Kolokythas, O, Zierler, RE (2009). Use of sonography in thoracic outlet syndrome due to a dystonic pectoralis minor. J US Med, 28, 1235–8.Google ScholarPubMed
Ozçakar, L, Güney, MS, Ozdağ, F et al. (2010). A sledgehammer on the brachial plexus: thoracic outlet syndrome, subclavius posticus muscle, and traction in aggregate. Arch Phys Med Rehabil, 91, 656–8.Google Scholar
Park, DY, Kang, S, Kang, HJ et al. (2019). Impact of neck position on the probability of common carotid artery puncture during ultrasound guided stellate ganglion block. PM&R J. Inj. Funct. Rehabil, 11, 463–9. https://doi.org/10.1016/j.pmrj.2018.08.376Google ScholarPubMed
Peet, RM, Henriksen, JD, Anderson, TP, Martin, GM (1956). Thoracic-outlet syndrome: evaluation of a therapeutic exercise program. Proc Staff Meet Mayo Clin, 31, 281–7.Google ScholarPubMed
Plewa, MC, Delinger, M (1998). The false-positive rate of thoracic outlet syndrome shoulder maneuvers in healthy subjects. Acad Emerg Med, 5, 337–42.Google Scholar
Rahman, A, Hamid, A, Inozemtsev, K, Nam, A (2019). Thoracic outlet syndrome treated with injecting botulinum toxin into middle scalene muscle and pectoral muscle interfascial planes: a case report. A A Pract, 12, 235–7. https://doi.org/10.1213/XAA.0000000000000894Google ScholarPubMed
Rob, CG, Standeven, A (1958). Arterial occlusion complicating thoracic outlet compression syndrome. BMJ, 20, 709–12.Google Scholar
Sanders, RJ, Annest, SJ (2017). Pectoralis minor syndrome: subclavicular brachial plexus compression. Diagnostics (Basel), 7, 46. https://doi.org/10.3390/diagnostics7030046CrossRefGoogle ScholarPubMed
Sanders, RJ, Hammond, SL, Rao, NM (2008). Thoracic outlet syndrome: a review. Neurologist, 14, 365–73.CrossRefGoogle ScholarPubMed
Simpson, DM, Blitzer, A, Brashear, A et al. (2008). Assessment: botulinum neurotoxin for the treatment of movement disorders (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70, 1699–706.Google Scholar
Singh, JA, Mahowald, ML, Noorbaloochi, S (2009). Intra articular botulinum toxin type A for refractory shoulder pain A randomized, double-blinded, placebo-controlled trial. Transl Res, 153, 205–16.Google Scholar
Smith, J, Finnoff, JT (2009). Diagnostic and interventional musculoskeletal US: part 1. Fundamentals. PM R, 1, 64–75.Google Scholar
Speelman, JD, Brans, JW (1995). Cervical dystonia and botulinum treatment: is electromyographic guidance necessary? Mov Disord, 10, 802.Google Scholar
Stapleton, C, Herrington, L, George, K (2009). Sonographic evaluation of the subclavian artery during thoracic outlet syndrome shoulder manoeuvres. Man Ther, 14, 19–27.CrossRefGoogle ScholarPubMed
Torriani, M, Gupta, R, Donahue, DM (2010). Botulinum toxin injection in neurogenic thoracic outlet syndrome: results and experience using a US-guided approach. Skel Radiol, 39, 973–80.CrossRefGoogle Scholar
Truong, D, Brodsky, M, Lew, M et al. (2010). Long-term efficacy and safety of botulinum toxin type A (Dysport) in cervical dystonia. Parkinsonism Relat Disord, 16, 316–23.CrossRefGoogle ScholarPubMed
Tsao, B (2007). True neurogenic thoracic outlet syndrome. Case report 18, AANEM, 7, 1–7.Google Scholar
Urschel, HC, Kourlis, H (2007). Thoracic outlet syndrome: a 50-year experience at Baylor University Medical Center. Proc Bayl Uni Med Cent, 20, 125–35.Google Scholar
Wright, IS (1945). The neurovascular syndrome produced by hyperabduction of the arms. The immediate changes produced in 150 normal controls, and the effects on same persons of prolonged hyperabduction of the arms, as in sleeping, and in certain occupations. Am Heart J, 29, 1.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×