Pain Management Procedures
Muscle Injections for Thoracic Outlet and Chest-Wall Pain
Muscle Injections for Thoracic Outlet and Chest-Wall Pain
What are these injections?
Tight, overactive, or painful muscles can irritate nearby nerves and contribute to pain. APG's list includes injections of the anterior scalene and pectoralis minor for selected thoracic outlet symptoms, as well as serratus anterior and pectoralis major injections for chest-wall pain. Depending on the diagnosis, the treatment may be a trigger-point injection, local anesthetic injection, corticosteroid injection, or botulinum toxin injection.
When may they be recommended?
These injections are considered only after the symptom pattern has been evaluated carefully. Thoracic outlet syndrome can involve nerves or blood vessels and can resemble cervical radiculopathy, shoulder disease, or other conditions. A targeted anesthetic injection may help predict whether a particular muscle is compressing or irritating nearby structures. Trigger-point injections are used when a palpable tender band reproduces the usual pain.
What happens?
Ultrasound is especially important for deep neck and chest muscles because major nerves, blood vessels, and the lung are nearby. The needle is guided into or alongside the selected muscle, and a small amount of medication is injected. The clinician may ask whether the familiar pain is reproduced.
What should I expect?
Muscle soreness is common for a day or two. Temporary weakness can occur, depending on the muscle and medication. The injection is usually paired with posture, breathing, stretching, or strengthening work rather than used by itself.
Important risks
Risks include bleeding, infection, nerve or blood-vessel injury, local-anesthetic toxicity, temporary weakness, and pneumothorax. Botulinum toxin has additional risks, including unintended weakness and swallowing or breathing problems. Seek urgent care for breathing difficulty, rapidly increasing swelling, or new major arm weakness.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.