Thoracic outlet compression syndrome is a complex syndrome of neurovascular compression at the superior thoracic aperture, thought to occur at 1 of 3 anatomical compartments: the interscalene triangle, the costoclavicular space, and the retropectoralis minor space. Injection into the middle interscalene muscle (ISM) and/or pectoralis muscle plane (PECS I and II) is gaining popularity because it provides significant symptomatic relief. A 44-year-old woman was diagnosed with thoracic outlet compression syndrome, with failed conservative therapy, including physical therapy. She refused surgical intervention. ISM and PECS I and II blocks with botulinum toxin type A were successful. In combination, PECS I/II and ISM injections can provide excellent symptomatic relief.
From the Department of Anesthesiology, John H. Stroger Cook County Hospital, Chicago, Illinois.
Accepted for publication August 14, 2018.
The authors declare no conflicts of interest.
Address correspondence to Abed Rahman, MD, MS, Department of Anesthesiology, John H. Stroger Cook County Hospital, 1969 W Ogden Ave, Chicago, IL 60612. Address e-mail to Arahman2@cookcountyhhs.org.