What does Botox have to do with thoracic outlet syndrome? Most often associated with reducing wrinkles and helping people look younger, Botox has recently been shown to help reduce symptoms of thoracic outlet syndrome. What is TOS and why could Botox help?

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome, also called TOS, is a condition in which a bundle of nerves and/or arteries becomes pinched as they pass from the cervical region to the arm. This pinching is often intermittent and can cause symptoms including pain, tingling, weakness, and feelings of heaviness or cold sensations in the arm or hand. Such symptoms can have a great impact on the ability to use the arm with functional activities.

Pinching of the neurovascular bundle can be caused by an elevated first rib, tightness in the scalene muscles, or a narrowing of the space between the clavicle and first rib. Most TOS symptoms are caused by trauma following a motor vehicle accident but can be related to poor posture such a sitting at a computer in a rounded shoulder fashion or muscle trauma following lifting.

Typical Treatment

TOS can be a difficult syndrome to treat. Physical therapy, medication, nerve blocks, and surgery are typical treatment options. Frequently physical therapy is implemented in order to help minimize tightness of the scalene muscle in order to reduce neurovascular pressure. Despite these treatment options, successful resolution of symptoms can be difficult.

How Can Botox Help?

A recent study evaluated the use of Botox in the treatment of TOS. Botox is a toxin that functions in the body by paralyzing muscles. Too much of this toxin can be deadly but in smaller doses the reduction in muscle spasticity and tightness can have therapeutic benefits.

In the most recent study evaluating its effect on TOS symptoms, Botox was injected into the anterior scalene muscle of 27 patients that were candidates for surgery. The goal of the Botox was to reduce scalene spasticity and tightness, thus minimizing pinching within the thoracic outlet. The injection of the Botox was guided by the use of a CT scan to ensure the substance was injected into the correct muscle. Follow up after three months found a 30% reduction in symptoms.

For those facing possible surgery, this amount of pain reduction can have significant functional impact. Activities such as brushing teeth, eating, and carrying children can significantly improve. However, because the effect of the drug wears off within a few months, repeat injections would be necessary to keep symptoms at bay. For those facing surgery, Botox injections may be an alternative therapy worthy of consideration.