Single CT-guided chemodenervation of the anterior scalene muscle with botulinum toxin for neurogenic thoracic outlet syndrome

Paul Christo, Dana Christo, Adam J. Carinci, Julie A. Freischlag

Research output: Contribution to journalArticle

Abstract

Objective: To examine pain relief in patients with neurogenic thoracic outlet syndrome (NTOS) after a single, low dose injection of botulinum toxin A (Botox) into the anterior scalene muscle (ASM) under computed tomographic (CT) guidance. Design: Prospective longitudinal study. Setting: Academic medical institution. Patients: Patients 18 years of age and older were evaluated for potential scalenectomy and first rib resection using the transaxillary approach at the study institution between 2005 and 2008. All patients had failed physical therapy. A total of 29 procedures on 27 participants were studied. Interventions: A single, 20-unit injection of Botox into the ASM under CT-guidance. Outcome Measures: Short-form McGill Pain Questionnaire (SF-MPQ) prior to and at 1, 2, and 3 months post-Botox toxin injection. Results: There was a decline in pain during the 3 months subsequent to Botox injection as noted by the following components of the SF-MPQ: sensory (P = 0.02), total (P = 0.05), visual analog scale (VAS [. P = 0.04]), and present pain intensity (PPI) score (P = 0.06). The proportion of patients reporting more intense pain scores did not return to the pre-intervention level at 3 months post-Botox injection. Conclusion: Patients experienced substantial pain relief in months 1 and 2 following a single Botox injection into the ASM under CT guidance. Significant pain reduction was noted for 3 months after Botox injection with respect to both sensory and VAS scores, and the total and PPI scores approximated statistical significance. After 3 months, patients experienced a 29% decrease in the sensory component of their pain as well as an approximate 15% reduction in their VAS score. A single, CT-guided Botox injection into the ASM may offer an effective, minimally invasive treatment for NTOS.

Original languageEnglish (US)
Pages (from-to)504-511
Number of pages8
JournalPain Medicine
Volume11
Issue number4
DOIs
StatePublished - Apr 2010

Fingerprint

Thoracic Outlet Syndrome
Type A Botulinum Toxins
Botulinum Toxins
Nerve Block
Pain
Muscles
Injections
Pain Measurement
Ribs
Visual Analog Scale
Longitudinal Studies
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Anterior Scalene Muscle
  • Botulinum Toxin (Botox)
  • Computed Tomographic Imaging (CT)
  • McGill Pain Questionnaire
  • Pain Relief
  • Thoracic Outlet Syndrome

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Single CT-guided chemodenervation of the anterior scalene muscle with botulinum toxin for neurogenic thoracic outlet syndrome. / Christo, Paul; Christo, Dana; Carinci, Adam J.; Freischlag, Julie A.

In: Pain Medicine, Vol. 11, No. 4, 04.2010, p. 504-511.

Research output: Contribution to journalArticle

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abstract = "Objective: To examine pain relief in patients with neurogenic thoracic outlet syndrome (NTOS) after a single, low dose injection of botulinum toxin A (Botox) into the anterior scalene muscle (ASM) under computed tomographic (CT) guidance. Design: Prospective longitudinal study. Setting: Academic medical institution. Patients: Patients 18 years of age and older were evaluated for potential scalenectomy and first rib resection using the transaxillary approach at the study institution between 2005 and 2008. All patients had failed physical therapy. A total of 29 procedures on 27 participants were studied. Interventions: A single, 20-unit injection of Botox into the ASM under CT-guidance. Outcome Measures: Short-form McGill Pain Questionnaire (SF-MPQ) prior to and at 1, 2, and 3 months post-Botox toxin injection. Results: There was a decline in pain during the 3 months subsequent to Botox injection as noted by the following components of the SF-MPQ: sensory (P = 0.02), total (P = 0.05), visual analog scale (VAS [. P = 0.04]), and present pain intensity (PPI) score (P = 0.06). The proportion of patients reporting more intense pain scores did not return to the pre-intervention level at 3 months post-Botox injection. Conclusion: Patients experienced substantial pain relief in months 1 and 2 following a single Botox injection into the ASM under CT guidance. Significant pain reduction was noted for 3 months after Botox injection with respect to both sensory and VAS scores, and the total and PPI scores approximated statistical significance. After 3 months, patients experienced a 29{\%} decrease in the sensory component of their pain as well as an approximate 15{\%} reduction in their VAS score. A single, CT-guided Botox injection into the ASM may offer an effective, minimally invasive treatment for NTOS.",
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