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

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Abstract
Botulinum toxin (BTX) injections into the musculature surrounding the brachial plexus have been examined as a potential treatment for neurogenic thoracic outlet syndrome (nTOS). This systematic review identified 15 publications, of which one was a randomized controlled trial (RCT). BTX injections performed with ultrasound (US) or electromyographic (EMG) guidance, and with the inclusion of the pectoralis minor muscle, in addition to the anterior and/or middle scalenes, tended to provide greater symptom improvement and may predict response to first rib resection. Importantly, most studies were of low quality; thus, the results should be interpreted with caution. Further high-quality studies are needed to confirm these findings.

Objectives: The objectives of this activity are to:1) Understand the challenges of diagnosing neurogenic thoracic outlet syndrome, and be able to differentiate neurogenic from venous and arterial thoracic outlet syndromes; 2) Be able to make appropriate choices of muscles for botulinum toxin injections for treatment of neurogenic thoracic outlet syndrome; 3)Compare and make appropriate decisions about methods of imaging guidance for treatment of neurogenic thoracic outlet syndrome.

ACCREDITATION STATEMENT
The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CREDIT DESIGNATION
The AANEM is accredited by the American Council for Continuing Medical Education (ACCME) to providing continuing education for physicians. AANEM designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit expires 4/1/2027

DISCLOSURE INFORMATION
The authors had no financial conflicts of interest.

FORMAT
PDF

Authors

Tyler T. Woodworth MD; Austin Le MD; Campbell Miller MD; Aaron Conger DO; Mark A. Mahan MD; Daniel M. Cushman MD.

Summary


Availability:	On-Demand
	Expires on Apr 01, 2027


Cost:	Member: $0.00 Non-Member: $25.00


Credit Offered:	1 CME Credit 1 CEU Credit