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Thoracic Outlet Syndrome Treated With Injecting Botulinum Toxin Into Middle Scalene Muscle and Pectoral Muscle Interfascial Planes

A Case Report

Rahman, Abed, MD, MS; Hamid, Albaraa, MD; Inozemtsev, Konstantin, MD; Nam, Andrew, MD

doi: 10.1213/XAA.0000000000000894
Case Reports

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.

Funding: None.

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

© 2019 International Anesthesia Research Society
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