Whiplash-induced Thoracic Outlet Syndrome Treated With Botulinum Toxin.

Inclusion Criteria:

• • Patient must have been diagnosed with a muscle strain to the lateral neck muscles following a car accident and there must be the following clinical signs of TOS: pain in the proper distribution, weakened grip, shoulder elevation on the appropriate side and numbness or tingling in the arm or fingers;

  • Patient must have no signs suggesting a radiculopathy that could account for similar symptoms;
  • Patient must have a PDQ >70, i.e. in the moderate to very severe disability range;
  • Patient must experience symptoms for longer than 3 months;
  • Patient must have had the accident leading to whiplash within the last 3 years;
  • Patient must be 18 years of age or older;
  • Patient must be eligible and agreeable to treatment with BoNT-A;
  • Patient must be toxin-naïve for the treatment of the cervical region, or have undergone a six months washout period;
  • Patient must be English speaking;
  • Patient must be able to provide informed consent.

Exclusion Criteria:

• • Patient unable or unwilling to complete the necessary assessment tasks;

  • Patient with hypersensitivity to botulinum neurotoxin type A or to any of the excipients, generalized disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome), or infection or inflammation at the proposed injection site(s);
  • Patient who requires physiotherapy and/or massage therapy;
  • Patient for whom concomitant medications are not controlled at study start and/or may require change/adjustment during the study;
  • Patient who had surgery which may interfere with the study;
  • Women who are pregnant or nursing, or women in age of reproduction not using a contraceptive method;
  • Patient in active litigation.