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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
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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

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