Impact of Scalene Muscle Botulinum Toxin Injection With and Without Surgery in Neurogenic Thoracic Outlet Syndrome.
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine
Scalene blocks are part of both the diagnostic and treatment algorithm for patients presenting with symptoms of neurogenic thoracic outlet syndrome (nTOS). However, there is a paucity of data on the utility of scalene botulinum toxin injection (BTI) before surgical decompression. We sought to determine the impact of BTI with and without surgery at a multidisciplinary referral center.Retrospective cohort study.Single institution tertiary academic center, 2011 to 2020.Seventy-seven consecutive patients.Scalene muscle BTI for nTOS with or without surgical decompression.Pain relief and Quick Disability of the Arm, Shoulder and Hand (QDASH) score.Seventy-seven patients, with a mean age of 31.4 years, had BTI for symptoms of nTOS. All patients underwent pretreatment physical therapy through the Edgelow protocol for a mean duration of 3.4 months. However, 72.7% had dynamic vascular compression on duplex ultrasound with provocative maneuvers and 85.7% had a positive physical examination finding. After BTI, 77.9% reported subjective relief, confirmed by an improved QDASH disability score. Thirty-one patients (40.3%) then went on to have further persistent symptoms and proceeded with first rib resection. After BTI + Surgery, 96.8% reported symptomatic relief and had a median QDASH score improvement of 21 (range: 10-40), with all reaching minimal clinically important differences in the QDASH score after combination therapy.In this reported series of chemodenervation in patients with nTOS, BTI is helpful in alleviating symptoms before definitive surgical decompression. BTI followed by first rib resection provides additional symptom improvement over BTI alone.
View details for DOI 10.1097/JSM.0000000000001094
View details for PubMedID 36367782
- Malignant Pilomatricoma of the Lower Extremity: A Difficult and Rare Diagnosis CUREUS JOURNAL OF MEDICAL SCIENCE 2022; 14 (2)
Malignant Pilomatricoma of the Lower Extremity: A Difficult and Rare Diagnosis.
2022; 14 (2): e21957
Malignant pilomatricoma is a rare cutaneous malignancy that is commonly found on the head and neck. We present a patient with malignant pilomatricoma of the lower extremity with intralesional calcification and giant cells, confirmed by histopathology. This patient's case represents a clinically important variation of malignant pilomatricoma in an uncommon anatomical location.
View details for DOI 10.7759/cureus.21957
View details for PubMedID 35282549
View details for PubMedCentralID PMC8903812
Impact of Scalene Muscle Botulinum Toxin Injection with and without Surgery in Neurogenic Thoracic Outlet Syndrome
MOSBY-ELSEVIER. 2021: E410
View details for Web of Science ID 000707158200201
- Evidence-Based Management of Medial Tibial Stress Syndrome in Runners CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021
Predictors Of Relief Following Botulinum Injection For Thoracic Outlet Syndrome
LIPPINCOTT WILLIAMS & WILKINS. 2021: 377
View details for Web of Science ID 000693955700413
Predicting Return To Play In NCAA Division 1 Athletes With Neurogenic Thoracic Outlet Syndrome
LIPPINCOTT WILLIAMS & WILKINS. 2021: 390
View details for Web of Science ID 000693955700448