A case of postthoracotomy syndrome with involuntary movement treated using botulinum toxin A

Abstract

We report the case of a 66-year-old woman with involuntary movement and muscle pain in the back as a sequel to thoracotomy. The patient had previously undergone upper lobe resection of the right lung for bronchiectasis. Two months later, the muscle next to the operation scar in her back began to twitch intermittently. The involuntary movement was accompanied with severe local pain extending from the operation scar to the anterior chest. Her symptoms remained refractory to drug therapy and nerve blocking. Botulinum toxin A (BTXA) was injected into the muscle surrounding the scar to treat the involuntary movement. This movement and pain around the scar completely disappeared. BTX-A was also injected into the anterior chest muscle, and the pain in the anterior chest was relieved. BTX-A not only decreased the involuntary movement, but also relieved the pain. Moreover, it can be used for the treatment of refractory neuropathic pain after thoracotomy even if its mechanism is not yet fully understood.