Possible role of the botulinum toxin in the management of neurogenic thoracic outlet syndrome: a systematic review.
Alban Fouasson-Chailloux, Thomas Jager, Pauline Daley and 5 others
PMID 37737048WHAT IT FOUND
Botulinum toxin injections for neurogenic thoracic outlet syndrome show inconsistent results.
The only high-quality randomized trial found no significant improvement in pain or function compared to placebo, while lower-quality retrospective studies reported symptom relief. Current evidence does not support its use as a validated treatment.
Key findings
01The single randomized controlled trial included in the review found no statistically or clinically significant improvement in pain, paresthesia, or function for patients receiving botulinum toxin compared to placebo.
02Most included studies were low-quality retrospective case series with heterogeneous injection sites, doses, and outcome measures, preventing a meta-analysis and limiting certainty.
03Adverse event reporting was highly inconsistent, ranging from zero complications in one study to 100% in another, with no standardized definition of what constituted a side effect.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included only one high-quality randomized controlled trial, which was negative. Most studies were retrospective case series with no control groups, leading to high risk of bias. There was extreme heterogeneity in injection sites, doses, and diagnostic criteria for NTOS. Outcome measures were not standardized; some studies used vague 'symptom relief' without validated scales. Adverse event reporting was inconsistent and potentially underreported or overreported depending on the study's definition of a complication. The authors could not perform a meta-analysis due to the poor quality and heterogeneity of the included studies.
Declared interests
The authors declared no conflicts of interest with any financial organization.
The easy way to misread this
Do not interpret the positive results from the retrospective case series as evidence that botulinum toxin works for NTOS. These studies lacked control groups and used subjective, unstandardized outcome measures. The only randomized controlled trial, which is the highest level of evidence in this review, found no significant benefit compared to placebo.