Botulinum Neurotoxin Injection as a Therapeutic Option in Thoracic Outlet Syndrome Caused by a Supernumerary Scalenus Muscle: A Case Report
Published: February 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52959.15957
Margarida Mota Freitas, Alexandre Camões Barbosa
1. Medical Doctor, Department of Physical and Rehabilitation Medicine, Hospital Garcia De Orta,, Almada, Portugal.
2. Medical Doctor, Department of Clinical Neurophysiology, Central Lisbon University Hospital Centre, Lisboa, Portugal.
Correspondence
Dr. Margarida Mota Freitas,
Avenida Torrado Da Silva, Almada, Portugal.
E-mail: margaridafmfreitas@gmail.com
Thoracic Outlet Syndrome (TOS) is a neurovascular syndrome and may occur as a result of compression of brachial plexus elements and/or subclavian vessels as they traverse the cervicoaxillary canal. One of the causes of TOS is the existence of a supernumerary scalene muscle, usually denominated as scalenus minimus. Botulinum Toxin Type A (BoNT-A) acts by binding presynaptically to high-affinity recognition sites on the cholinergic nerve terminals and decreases the release of acetylcholine, suppressing muscle overactivity. BoNT-A reduces contraction in injected muscles, causing focal chemodenervation and has been described as a non surgical effective treatment in selected cases of TOS. Here, is the case of a 44-year-old woman diagnosed with refractory TOS, who presented with paresthesia in the fourth and fifth fingers of her right hand, associated with a feeling of lack of coordination in the same hand. On Magnetic Resonance Imaging (MRI), a supernumerary scalene muscle was identified as a probable cause of TOS. She was treated with chemodenervation of the scalenus anterior muscle (30 Units) and scalenus medius muscle (30 Units), using incobotulinumtoxin A. The patient had a very significant clinical improvement after Anterior Scalene (AS) and Middle Scalene (MS) muscle BoNT-A injections. Incobotulinumtoxin A neurotoxin injection is a therapeutic option in TOS.
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