Practical Atlas of Ultrasound for Anesthesia in Chronic Pain

Document Type

Book Chapter

Publication Date

4-3-2025

Publication Title

Practical Atlas of Ultrasound for Anesthesia in Chronic Pain

Abstract

Thoracic outlet syndrome (TOS) is a complex neurovascular disorder affecting any of the three anatomical compartments: the interscalene triangle, the costoclavicular space, and the retropectoralis minor space [1]. Compression of the nerves, veins, and arteries in the thoracic outlet produces neurosensory and pain symptoms affecting the neck, upper chest, shoulder, arm, and hand [2]. Subcategories of TOS include neurogenic TOS (NTOS), arterial TOS (ATOS), and venous TOS (VTOS), with nearly 90% of all TOS cases consisting of neurologic origin [1]. Accurate diagnosis of TOS has proven to be difficult due to its complex etiology, as well as there being no existing definitive diagnostic test [1, 2]. Current advances in diagnostic methods include provocative injections using local anesthetic, which test for positive pain relief [2]. Treatment for NTOS ranges from conservative approaches, such as physical therapy, to more invasive approaches. Invasive treatment consists of injections of local anesthetic or botulinum toxin type A (BTX-A) prior to/in conjunction with surgery [1, 2]. Presently, scalene and pectoralis injections for NTOS may yield positive temporary relief and serve as a minimally invasive treatment compared to decompressive surgery [1, 2].

First Page

37

Last Page

40

Chapter Title

Chapter 8 - Scalene and Pectoralis Injections for Thoracic Outlet Syndrome

ISBN

[9781040258385, 9781032625904]

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