Evaluation of clinical efficacy on interscalene injections by ultrasound-guided for neurogenic thoracic outlet syndrome and ultrasonic observation

Abstract

Neurogenic Thoracic Outlet Syndrome (nTOS) is a clinical diagnosis that describes the symptomatic manifestation of the compression of brachial plexus. The objective of this study is to evaluate the therapeutic effects of interscalene injections by ultrasound-guided for nTOS and observe the ultrasonic characteristics of brachial plexus and their surroundings. Thirty suspect patients with nTOS were received tow stages treatments. First stage, all patients were received one-week conventional therapies, that included analgesics treatment and psychological treatment; after that, the patients were given drug discontinuance 3 days. Then patients were got into the second stage, that were treated with interscalene injections by ultrasound-guided ( Fig. 1 ). The changes of Vsiual Analogue Scale (VAS) scores before and after 2 stages treatment were recorded. At the interscalne level, the sonography and anatomic variations of the brachial plexus, superior and middle scalene muscles were observed ( Fig. 2 ). Before treatment the VAS sores were (8.25 ± 1.53), after 2 weeks of treatment,the VAS sores were(2.57 ± 1.06),comparisons of these tow VAS scores, there were significant differences ( P < 0.05). At the interscalene level, the brachial plexus were identified in the transverse view as round to oval hypoechoic structures, anterior and middle scalene muscles showed hyperechoic structures ( Fig. 3 ). There were 16 patients whose three trunks of the brachial plexus passed through between the anterior and middle scalene muscles, accounted for 53.33% of the total; 10 patients’ superior trunks of the brachial plexus pierced the anterior scalene muscle, their middle trunks and lower trunks passed through between the anterior and middle scalene muscles, accounted for 33.33% of the total; 4 patients’ superior and middle trunks pierced the anterior scalene muscle, their lower trunks passed through between the anterior and middle scalene muscles, accounted for 13.33% of the total. Accurate positioning of interscalene injections by ultrasound-guided for the treatment of nTOS could have certain efficacy. There are variations in the brachial plexus crossing the scalene triangle.