508 - Botox Treatment for Cervical Tightness in Patient with History of Astrocytoma

Case Diagnosis: 49-year-old female with neck and shoulder tightness

Case Description: 49-year-old female with history of recurrent cervical astrocytoma status-post cervical decompressions complicated by syringomyelia presented for chronic neck, shoulder, and upper back tightness. She also reported ongoing bilateral upper extremity numbness and dysesthesias. She was taking gabapentin and as needed cyclobenzaprine. Exam demonstrated pronounced upper thoracic kyphosis, scarring of posterior cervical and upper thoracic regions, limited cervical range of motion, increased tone in bilateral trapezius and periscapular musculature, and tenderness to palpation of sternocleidomastoid and upper trapezius bilaterally. She underwent trigger point injections and dry needling to the bilateral upper trapezius with moderate yet transient relief. She subsequently underwent a trial of botulinum toxin injections to upper and middle trapezius muscles bilaterally to alleviate excess shoulder elevation and scapular retraction. Four weeks following her procedure, she endorsed significant reduction in tightness and dysesthesias, with no reported side effects, and overall improvement in sleep and daily functioning.

Discussions: Chronic neck and shoulder girdle tightness can cause significant pain and disability, decreasing quality of life. Botulinum toxin injections are commonly used for focal spasticity management and cervical dystonia, though it is not a common treatment modality for persistent muscle tightness. Conventional treatments include physical therapy, trigger point injections, or pharmacologic agents such as neuropathics, anti-inflammatories, and muscle relaxants. This patient’s symptomatic and functional improvement following her botulinum toxin injections suggests it as a potential option for chronic, refractory muscular tightness and hypertonicity in those who have failed other conservative measures and are interested in minimally invasive yet focal approaches to target their symptoms and improve functionality.

Conclusions: We present a patient with persistent cervical and periscapular muscular tightness who responded to botulinum toxin injections. This case suggests utility in considering botulinum toxin injections as management for chronic neck and shoulder girdle tightness to improve symptoms and functionality.