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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:1235-1238 • 0278-4297

Technical Advance

Use of Sonography in Thoracic Outlet Syndrome Due to a Dystonic Pectoralis Minor

Ib R. Odderson, MD, PhD, Edward S. Chun, MD, Orpheus Kolokythas, MD and R. Eugene Zierler, MD

Departments of Rehabilitation Medicine (I.R.O.) and Radiology (O.K.) and Division of Vascular Surgery (R.E.Z.), University of Washington Medical Center, Seattle, Washington USA; and Overlake Hospital Medical Center, Bellevue, Washington USA (E.S.C.).

Address correspondence to Ib R. Odderson, MD, PhD, Department of Rehabilitation Medicine, University of Washington, Box 356490, 1959 NE Pacific St, Seattle, WA 98195 USA. E-mail: odderson{at}u.washington.edu

Objective. For patients with thoracic outlet syndrome (TOS), it is important to determine the location of the neurovascular compression to achieve effective intervention. Methods. The diagnostic workup for a 39-year-old man with TOS included a selective anesthetic block of the pectoralis minor muscle and duplex sonography before and after the block. Results. The subclavian artery peak systolic flow velocity decreased after the block from 208 to 63 cm/s when the arm was in the abduction and external rotation position, indicating a reduction in the severity of focal arterial compression. Also, the arterial diameter increased by 10% after the block (from 0.80 to 0.88 cm). His level of discomfort was reduced from 6 to 2 on a scale of 1 to 10 (66%). Conclusions. The pectoralis minor block resulted in an improvement in subclavian artery blood flow and symptoms and confirmed the diagnosis of pectoralis minor TOS. This suggests that selective anesthetic muscle blocks and duplex sonographic studies may be useful before chemodenervation and surgery.

Key Words: dystonia • electrodiagnostic studies • pectoralis minor • subclavian artery blood flow • thoracic outlet syndrome

Abbreviations: AER, abduction and external rotation • EMG, electromyography • PSV, peak systolic velocity • TOS, thoracic outlet syndrome

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