Disclosures: Ib R. Odderson, MD, PhD: No financial relationships or conflicts of interest

Case Description: A 40-year-old woman underwent her routine 4th chemodenervation for thoracic outlet syndrome and cervical dystonia. The day after injection her workplace was flooded, and she worked for 6 hours salvaging computers, boxes, and other equipment on the floor. The following day she was seen at the emergency department with a day of worsening dysphagia and unable to tolerate solid or liquid textures. On hospital day 2, our patient failed a bedside swallow test. On hospital day 3, the dysphagia had improved, and a video fluoroscopic swallow study induced strong productive cough after all textures but showed no aspiration. She was discharged after tolerating a general diet. Chemodenervation was performed under EMG and ultrasound guidance. She received her usual toxin injection to the left anterior and middle scalenes (25 units each, 100 units/mL), pectoralis minor and levator scapulae (50 units each, 50 units/mL), and upper trapezius (25 units, 50 units/mL). The procedure was well tolerated without immediate complications.

Setting: Outpatient clinic at Tertiary care university hospital

Patient: 40-year-old female with cervical dystonia and thoracic outlet syndrome Assessment/

Results: At follow-up 12 days after injection she still had mild increased work of swallowing, without signs of aspiration

Discussion: This is the first reported case, to our knowledge, of exercise induced dysphagia following cervical chemodenervation. Exercise appears to have increased the spread of the neuro toxin to the pharyngeal constrictor muscles causing dysphagia

Conclusion: Chemodenervation of the scalene muscles followed by exercise may increase the risk of neurotoxin toxin spread and cause dysphagia

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/exercise-induced-dysphagia-following-cervical-chemodenervation-using-onabotulinumtoxina-a-case-report/