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Post-traumatic delayed onset pectoralis myospasm secondary to α-γ dysfunction
  1. Dennis L Barnett II,
  2. Klinton McGhee,
  3. Paul Bungee
  1. Madigan Army Medical Center, Tacoma, Washington, USA
  1. Correspondence to Dr Dennis L Barnett II, dennis.barnett{at}


A restrained motor vehicle accident victim suffered from delayed onset left pectoralis myospasms refractory to multiple treatments: behavioural, conservative, physical therapy, opiate, muscle relaxer and incomplete response to invasive pain management spinal blocks. After conduction of a literature review, several authors had noted the mechanism of α-γ loop dysfunction resulting in myospams, and also case studies which described painful postsurgical myospasms that were treated with neurectomy and/or botulinum toxin A with successful results. The patient in this case underwent an initial lidocaine injection to observe response to treatment, followed by two treatments with botulinum toxin A treatment with subsequent resolution of symptoms. Successful therapy and previous research supports that botulinum toxin A can be an effective treatment for myospasms secondary to trauma-induced α-γ dysfunction, as suggested by the cellular pathophysiology.

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