What is the role of botulinum toxin in the treatment of thoracic outlet syndrome?

Updated: Jan 10, 2019
  • Author: Daryl A Rosenbaum, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Injection of botulinum toxin into the muscles of the thoracic outlet (scalenes, pectoralis minor, subclavius) has potential for obtaining long-term symptom relief, but further research is needed. [51]

A 2014 Cochrane review looked to evaluate outcome studies of treatments of TOS that took place at a minimum of 6 months after the intervention. [52] The review found that there was very low quality evidence that transaxillary first rib resection decreased pain more than supraclavicular neuroplasty, and found no randomized evidence that either treatments is better than no treatment at all. The review also reported that there is moderate evidence to suggest that treatment with botulinum toxin injections yielded no great improvements over placebo injections of saline. There is no evidence from randomized controlled trials for the use of other currently used treatments. The review concluded that there is a need for an agreed definition for the diagnosis of TOS, agreed outcome measures, and high quality randomized trials that compare the outcome of interventions with no treatment and with each other. [52]

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