Invited Review: Botulinum Toxin Injections for the Treatment of Neurogenic Thoracic Outlet Syndrome A Systematic Review-Article

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The document discusses the use of botulinum toxin (BTX) injections as a potential treatment for neurogenic thoracic outlet syndrome (nTOS) through a systematic review of 15 publications, including one randomized controlled trial. The injections are aimed at the musculature surrounding the brachial plexus. The review highlights that most studies were of low quality, emphasizing the need for high-quality studies to confirm the findings. Studies suggest that BTX injections, especially when guided by ultrasound or electromyography and targeting specific muscles like the pectoralis minor in addition to the scalene muscles, tend to provide symptom improvement and may predict responses to surgical interventions like first rib resection.<br /><br />The document explains the challenges in diagnosing TOS, the classification of TOS into different types, and the various treatments available based on the etiology and healthcare provider. It notes that initial treatment usually involves conservative management with physical therapy and activity modification, with surgical interventions like first rib resection and/or scalenectomy being indicated for persistent symptoms.<br /><br />The review also discusses the methodological flaws in the studies analyzed, including inconsistencies in diagnostic criteria, treatment protocols, outcome measures, and a high risk of bias, which hinder the ability to determine the true effectiveness of BTX for nTOS treatment. The document concludes that while BTX injections may offer benefits for nTOS patients, more high-quality studies are required for conclusive evidence.

Keywords

Botulinum toxin injections

Neurogenic thoracic outlet syndrome

Brachial plexus

Ultrasound guidance

Electromyography

Pectoralis minor muscle

Scalene muscles

First rib resection

Physical therapy

Scalenectomy

EMG