Thoracic Outlet Syndrome
Conditions
Keywords
Thoracic Outlet Syndrome (TOS), Botulinum Toxin, Botox, Pain
Brief summary
The purpose of this study is: 1. To assess the effect of BOTOX injection to the scalene muscles on the severity of pain from TOS. 2. To assess the effect of BOTOX injection on numbness and tingling and quality of life.
Detailed description
Background: Thoracic Outlet Syndrome (TOS) is a symptom complex consisting of pain, paresthesias and often functional impairment caused by compression of the neurovascular supply to the upper limb. Impingement may occur at the interscalene triangle, and both anesthetic blockade and chemodenervation of the scalene muscles have been shown to temporarily improve symptoms of TOS in non-randomized controlled trials. Objective: To assess the effect of Botulinum Toxin Type A (BTX-A) injections into the scalene muscles on pain, paresthesias and function in subjects with TOS. Hypothesis: BTX-A injected into the anterior and middle scalene muscles will reduce the irritation on the neurovascular structures at the interscalene triangle in subjects with TOS. This will lead to reductions in pain and paresthesias, and improvements in function when compared with injection of placebo. Intervention: Each subject will receive an injection under EMG guidance into the anterior and middle scalene muscles of either 75 units of BTX-A (experimental group), or normal saline (control group). Both groups will be provided with a stretching and strengthening exercise program.
Interventions
DRUGBotulinum Toxin Type A injection (BOTOX)
Each subject will receive an injection under EMG guidance into the anterior and middle scalene muscles of either 75 units of BTX-A (experimental group), or normal saline (control group). Both groups will be provided with a stretching and strengthening exercise program.
Sponsors
Allergan
University of British Columbia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age at least 19 years * Medically stable * Able to give informed consent * Meets criteria for clinical diagnosis of TOS * Symptoms of TOS present for at least six months * Have had EMG studies and a CT or MRI scan of the cervical spine
Exclusion criteria
* Prior treatment with BTX-A * Allergy to BTX-A * History of botulinum toxicity * Prior scalenectomy * Surgery for TOS planned within six months * Use of blood thinners, i.e., warfarin; unfractionated or low molecular weight heparin * History of Myasthenia Gravis, Eaton-Lambert Syndrome or Shy-Drager Syndrome * Unable to complete follow-up assessments at 6 weeks, 3 months and 6 months * Any abnormalities on EMG, CT or MRI studies suggesting an alternate diagnosis * Pregnancy or planned pregnancy within six months
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Pain as measured on Visual Analog Scale (VAS) at 6 weeks, 3 months and 6 months post-intervention | 6 monhts |
Secondary
| Measure | Time frame |
|---|---|
| Paresthesias as measured on VAS | 6 months |
| Function as measured with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, SF-36, number of days lost from work | 6 months |
Countries
Canada
Outcome results
None listed