Treating Neurological Thoracic Outlet Syndrome Identified by a Provoked Electromyographic Sign: Analysis of the Data.

Having isolated a group of patients for whom a functional electrophysiological test is positive, we then treated the patients in a manner that would specifically address thoracic outlet syndrome. Direct injection of botulinum neurotoxin into the scalenus anticus and medius relieved pain and contemporaneously reduced the positivity of the test, suggesting that the functional maneuver is sensitive to the pathogenetic mechanism. After 6–8 weeks, as the botulinum toxin΄s efficacy waned, both pain and positivity of the functional maneuver increased somewhat. Fortunately, physical therapy kept both under some control. [ABSTRACT FROM AUTHOR]