Selective Botulinum Chemodenervation of the Scalene Muscles for Treatment of Neurogenic Thoracic Outlet Syndrome

Jordan, Sheldon E.; Ahn, Samuel S.; Freischlag, Julie A.; Gelabert, Hugh A.; Machleder, Herbert I.

doi:10.1007/s100169910079

Cited by 119 publications

(100 citation statements)

References 11 publications

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“…In our study, 68/83 (82%) of the anesthetic injections into the ASM alone or ASM/MSM together resulted in a positive scalene block, which was higher than that in studies using needle guidance by sonography (11/29, 38%), 11 EMG and fluoroscopy (4/22, 18%), 20 or EMG alone (93/122, 72%). 12 Although placebo effects and coexisting spinal pathology may challenge the results of our study, the high rate of improvement (70%) after surgery retrospectively verifies cases of true NTOS.…”

Section: Resultscontrasting

confidence: 63%

“…18,20 Success rates by these means are expected to be very operator-dependent based on experience, whereas CT guidance lends a simplicity and accuracy that would allow a shorter learning curve. With no imaging guidance, there is a high possibility of a false-positive result because of accidental BP anesthesia (Յ10% of cases) 12 or a false-negative result due to inaccurate targeting of the scalene muscles or inadvertent puncture of important vascular structures.…”

Section: Resultsmentioning

confidence: 99%

“…12,13 When blocks are performed by means of fluoroscopy and EMG, there may be a 1.2%-7% rate of dysphagia and a 0.6% rate of undesired muscle weakness. 18,20 Moreover, frequent paresthesia during needle placement has been reported. 18 Torriani et al 11 performed 29 sonographically guided anesthetic injections of the ASM and experienced temporary BP blocks in 10/29 (34%) injections.…”

Section: Resultsmentioning

confidence: 99%

“…Compared with the use of superficial anatomic landmarks, 12,13 sonographic guidance, 11 or fluoroscopic and EMG guidance, 18,20 CT guidance minimized the occurrence of Horner sign, dysphonia, BP block, and dysphagia and produced a comparably low rate of upper extremity muscle weakness or intravascular needle placement with no vascular uptake following local anesthetic or botulinum toxin injection. Our results indicate that under CT guidance, scalene injection is a safe procedure.…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

CT-Guided Injection of the Anterior and Middle Scalene Muscles: Technique and Complications

Mashayekh

Christo²,

Yousem³

et al. 2011

AJNR Am J Neuroradiol

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Section: Resultscontrasting

confidence: 63%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

CT-Guided Injection of the Anterior and Middle Scalene Muscles: Technique and Complications

Mashayekh

Christo²,

Yousem³

et al. 2011

AJNR Am J Neuroradiol

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show abstract

“…Recentemente, alguns autores mostraram alívio temporário de sintomas com o uso de toxina botulínica (Botox) na musculatura escalênica, o qual poderia ser preditivo de igual sucesso em futura intervenção cirúrgica eventualmente necessária 10 . A indicação de cirurgia deverá ser cogitada para pacientes cujos sintomas sejam resistentes ao tratamento clínico, comprometam a qualidade de vida ou alterem a condução nervosa provocando atrofias musculares ou dores crônicas 1 .…”

Section: Descrição Da Técnicaunclassified

Síndrome do desfiladeiro torácico - ressecção de costela cervical por videotoracoscopia

et al. 2012

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ResumoA base do tratamento cirúrgico da Síndrome do Desfiladeiro Torácico (SDT) é a ressecção da primeira costela, podendo associar-se à escalenectomia ou ainda à ressecção de costela cervical. Esta última é feita tradicionalmente por meio de um acesso supraclavicular ou mesmo axilar, o qual é tecnicamente mais trabalhoso. Pode ser realizada também por meio de acesso paraescapular. Embora tecnicamente atrativa e associada à menor invasividade e maior segurança, com ótimo resultado estético, a ressecção da primeira costela torácica, por intermédio de cirurgia videoassistida transaxilar ou pela técnica videotoracoscópica, é pouco relatada na literatura, e nenhuma referência foi encontrada sobre ressecção de costela cervical mediante essa técnica. Neste artigo, apresentamos essa inovação cirúrgica realizada com sucesso para ressecção de costela cervical em duas pacientes.Palavras-chaves: cirurgia vídeo-assistida; costela cervical; Síndrome do Desfiladeiro Torácico; Síndromes de Compressão Nervosa. AbstractThe basis of Thoracic Outlet Syndrome (TOS) surgical treatment is the first rib resection and may be associated with scalenectomy or cervical rib resection. The latter is traditionally done through a supraclavicular or axillary access, which is the most technically challenging. It can also be achieved through parascapular access. Although technically attractive and associated with less invasiveness and increased security, with excellent aesthetic results, the first thoracic rib resection via video-assisted transaxillary surgery or videothoracoscopic technique is seldom reported in the literature, and no reference was found on cervical rib resection through this technique. In this article, we introduced this innovation successfully performed for surgical cervical rib resection in two patients.Keywords: video-assisted surgery; cervical rib; Thoracic Outlet Syndrome; Nerve Compression Syndromes. IntroduçãoA abertura superior do tórax é delimitada em sua base pela primeira costela, pela face anterolateral do corpo da primeira vértebra torácica (T1) e pela borda superior do manúbrio esternal. O desfiladeiro torácico inclui três espaços estreitos (por isso o nome desfiladeiro) que se estendem da abertura do tórax até a região axilar. A porção proximal desse desfiladeiro inclui o triângulo interescaleno, formado entre o escaleno anterior e médio, e o espaço costoclavicular, formado

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Treatment for thoracic outlet syndrome

Povlsen

Belzberg

Hansson³

et al. 2010

Cochrane Database of Systematic Reviews

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This review was complicated by a lack of generally accepted diagnostic criteria for the diagnosis of TOS. There was very low quality evidence that transaxillary first rib resection decreased pain more than supraclavicular neuroplasty but no randomized evidence that either is better than no treatment. There is no randomized evidence to support the use of other currently used treatments. There is a need for an agreed definition for the diagnosis of TOS, especially the disputed form, agreed outcome measures and high quality randomized trials that compare the outcome of interventions with no treatment and with each other.

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Selective Botulinum Chemodenervation of the Scalene Muscles for Treatment of Neurogenic Thoracic Outlet Syndrome

Cited by 119 publications

References 11 publications

CT-Guided Injection of the Anterior and Middle Scalene Muscles: Technique and Complications

CT-Guided Injection of the Anterior and Middle Scalene Muscles: Technique and Complications

Síndrome do desfiladeiro torácico - ressecção de costela cervical por videotoracoscopia

Treatment for thoracic outlet syndrome

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