Scalenus Anticus Syndrome Research Articles

Throwing can Increase the Stiffness of the Scalene Muscle

Objectives:Thoracic outlet syndrome (TOS) has been reported as a set of symptoms due to the compression of the brachial plexus and subclavian vessels in the region of the thoracic outlet1. As a type of TOS, scalenus anticus syndrome involves the compression of the brachial nerves as they pass through the interval surrounded by the anterior and middle scalene muscles, and the first rib bone or cervical rib2. Recently, exercise-induced TOS is becoming more common in athletes, especially for those who perform repetitive overhead and hyperabduction maneuvers with upper limbs, such as baseball players. However, the effect of throwing on the stiffness of the scalene muscles is unknown. Thus, the purpose of this study was to quantitatively measure the stiffness of the scalene muscles using real-time shear wave elastography (SWE). The stiffness of scalene muscles was hypothesized to increase for the throwing side of baseball players.Methods:Thirty college baseball players (age range 19 to 21 years) were included for this study. Ultrasonic SWE with a 2-10 MHz linear array probe transducer (Aixplorer; SuperSonic Imagine, Aix-en-Provence, France) was used to assess the stiffness of the anterior and middle scalene muscles. Each participant was sited. The measurements were performed in two arm positions; 1) adducted and neutral rotation of the shoulder 2)90 degree of abduction and external rotation of shoulder with elbow flexed to simulate a clinical examination known as Roos test3. In both of the arm positions, the transducer was positioned just superior to the clavicular bone, parallel to its axis. Transducer was moved superiorly and tilted to visualize the superior surfaces of the anterior and middle scalene muscles parallel to the surface of the fifth cervical nerve simultaneously (Figure 1A). In this position, shear wave elastography was performed to measure the elasticity of each scalene muscle as its stiffness. Each muscle was divided into superior and deep areas. In both areas of each muscle, three 3mm-diameter circles were set to measure the elasticities of the scalene muscles and its averaged data in each area was defined as each stiffness (Figure 1B). A repeated-measures analysis of variance (ANOVA) was used to compare the elasticity of superior and deep areas in anterior and middle scalene muscles in throwing and non-throwing side. Values of p<0.05 were considered statistically significant.Results:For the throwing side, higher stiffness was found in the deep part of the middle scalene muscle compared to the superior and deep parts of the anterior scalene muscle with an adducted and neutrally rotated shoulder (p=0.0433). Moreover, the muscle stiffness was significantly higher in the superior and deep part of the middle scalene muscle than in the superior and deep parts of anterior scalene muscle in an abducted and externally rotated position of shoulder (p =0.00187). Meanwhile, no significant difference was found in the anterior and middle scalene muscles for the non-throwing side in both arm positions.Conclusion:In professional athletes with TOS who experienced surgical treatment, moderate to severe hypertrophy of the anterior scalenus muscles has been reported to be found4. Meanwhile, although the stiffness of the scalene muscles can be also related to the compression on the brachial plexus and on subclavian vessels in the region of the thoracic outlet, its quantitative measurements in the scalene muscles has not been reported. In this study, at throwing side, the muscle stiffness significantly increased in the superior area of middle scalene muscle in throwing side. While no contribution was identified in the scalene muscles at non-throwing side. As a result, repeat throwing motion can increase the stiffness of the middle scalene muscle. As a result, the brachial plexus and/or the subclavian artery could be compressed at the interscalene triangle. Throwing athletes with TOS should be treated, considering the stiffness of the middle scalene muscle, even conservative or surgical treatment. Our study was the first study to evaluate the effects of throwing on the stiffness of the scalene muscles in throwing athletes. Repetitive throwing motion can affect the stiffness of middle scalene muscle. Reduction of the middle scalene muscle should be considered to treat throwing athlete who has TOS.Figure 1.

Exercise-Induced Scalenus Syndrome

Background Thoracic outlet syndrome is described as a group of distinct disorders producing signs and symptoms attributed to compression of nerves and blood vessels in the thoracic outlet region. Purpose To describe the exercise-induced scalenus anticus syndrome attributed to the anterior scalenus hypertrophy as a thoracic outlet syndrome underlying mechanism and to give recommendations for a safe and effective surgical treatment. Study Design Case series; Level of evidence, 4. Methods Twelve young professional athletes admitted for thoracic outlet syndrome (8 cases of neurologic thoracic outlet syndrome, 4 cases of mixed neurologic and vascular thoracic outlet syndrome) who reported numbness, tingling, early fatigue, muscle weakness, and pain were enrolled in the study. Scalenus hypertrophy was suspected to be the causative factor. Scalenectomy was performed in all cases. Results All patients had moderate to severe hypertrophy of the anterior scalenus muscle. Scalenectomy was performed, and there were no intraoperative or postoperative complications. Full activity was quickly achieved, and no recurrence of symptoms was documented. Conclusion Surgical intervention for scalenus anticus syndrome can allow an athlete to return to full activity and improve quality of life. Surgical intervention seems to be the treatment of choice in terms of restoring quality of life and physical activity.

Cervical Rib Syndrome - 2 Cases Report -

Cerivical rib syndrome, one of four common causes of thoracic outlet syndromes, have similar symptoms which accidentally discovered in simple x-ray and needs to be distinguished with other syndromes. Thoracic outlet syndromes are classified according to anatomical structures that causes symptoms; cervical rib syndrome, scalenus anticus syndrome, costoclavicular syndrome and hyperabduction syndrome. Various treatments for thoracic outlet syndromes have been introduced, such as; conservative care, excision of cervical rib and first rib and release of anterior scalenus muscle by supraclavicular approach and excision of cervical rib and first rib by axillary approach. We would like to report a case on a 16 years old girl and a 21 years old man who had cervical rib syndrome and treated successfully without excision of the first rib but excised cervical rib and released anterior scalenus muscle by supraclavicular approach.

Thoracic Outlet Syndromes— Application of Microcirculation Techniques and Clinical Review

The thoracic outlet syndromes of the upper extremities consist of many disorders. The most important two are the costoclavicular syndrome (compression of neurovascular structures between the clavicle and the first rib) and the scalenus anticus syndrome (compression of these structures within the scalene triangle). Congenital abnormalities of the clavicle, congenital small thoracic outlet, high first rib, cervical ribs of all configurations, pectoralis minor and pectoralis major syndromes, and others may occur. The costoclavicular syndrome and scalenus anticus syndrome have been considered the most prevalent compression syndromes and are amenable to surgical or medical treatment. Quantitative measurements of the microcirculation of the fingertip were examined with the shoulders and head in various positions to provide quantitative information relative to the costoclavicular and scalenus anticus syndromes. A laser instrument was ideal for this purpose, for results were quantitative and no counterpressure was applied during the measurement. The technic applied was highly successful in separating quantitatively the normal individuals from those with either costoclavicular syndrome or scalenus anticus syndrome.

Disparity in Blood Pressure Between Arms

To the Editor.— While the consultants in QUESTIONS AND ANSWERS (237:1871, 1977) are correct in stating that the most common cause of dissimilar blood pressure readings in the arms of a 77-year-old man is arteriosclerotic occlusion of the subclavian artery, they make no mention of alternative explanations that may be responsible or contributory. Asymmetrical sphygmomanometric recordings can occur with the scalenus anticus syndrome, a cervical rib, or other forms of the thoracic outlet syndrome. Adson's test is usually positive in these cases.1 Anesthesiologists as myself occasionally give anesthesia to these patients for unrelated surgery, and often positioning them on the operating table can incur a spurious hypotension in the affected arm. Contralateral normalrange Korotkoff sounds delineate the discrepancy, and repositioning amends it. Unilaterally diminished arterial pulsations may also be seen status after open heart surgery or cardiac catheterization. Checking the blood pressure in both arms is worthwhile not only

Digital Gangrene

The development of tissue necrosis of the tips of fingers and toes suggests Raynaud disease or Raynaud phenomenon. The latter is sometimes the signal manifestation in varied diseases, including scleroderma, pneumatic hammer disease, scalenus anticus syndrome, cervical rib, shoulder-hand syndrome (reflex sympathetic dystrophy), peripheral arterial disease (arteriosclerosis, thromboangiitis obliterans), drug poisoning (ergot, methysergide), and several hematologic disorders in which exposure to cold causes sludging of blood. Three recent reports in publications of the American Medical Association present other causes for consideration. In the current issue of<i>Archives of Internal Medicine</i>(136:1273-1280, 1976), Gipstein and his colleagues describe 11 patients with chronic renal insufficiency owing to various causes, who, while under treatment by long-term hemodialysis (five cases) or by functioning homotransplants (six cases), developed livedo reticularis and painful ischemic ulcers of the fingers or toes or both. In some cases, cutaneous necrosis also appeared in other areas of the lower extremities.

The Scalenus Anticus Syndrome and Competitive Swimming

Two cases of scalenus anticus syndrome occurring in competitive free-style swimmers were relieved by scalenotomy and the patients were able to return promptly and successfully to swimming competition. This experience has suggested the mechanism of an apparent causal relationship between freestyle swimming and the scalenus anticus syndrome. In both patients, cessation of competitive swimming resulted in remission of symptoms. Scalenotomy, however, proved to be a simple and effective means of preserving their swimming careers.

The scalenus anticus syndrome and competitive swimming. Report of two cases

The scalenus anticus syndrome and competitive swimming. Report of two cases

Unilateral Raynaud's phenomenon caused by cervical-first rib anomalies

Two cases of a complete cervical rib and one of an anomalous first rib causing subclavian artery thrombosis and distal arm thromboemboli are reported. In each case unilateral Raynaudis phenomenon, believed to be the consequence of small digital emboli, preceded serious thromboembolism by one year or longer. The vast majority of thromboembolic complications of the thoracic outlet syndromes are related to these two rib anomalies, which are usually identifiable on routine chest roentgenograms. Thromboembolism is an unusual complication of an incomplete cervical rib and the scalenus anticus syndrome. Diagnosis is made by arteriographic study of the subclavian artery and the distal circulation. The routine thoracic outlet maneuvers often contribute little to the diagnosis. Therapy consists of surgical removal of the subclavian artery thrombus and restoration of vascular integrity, excision of the cervical or anomalous first rib, transection of the scalenus anticus muscle, thoracocervical sympathectomy and an attempt to remove as much distal thrombus in the brachial-radial-ulnar vessels as possible. Results are optimal only if such surgery is performed before subclavian artery scarring and extensive distal embolization has occurred.

Statistical Studies on the Patient of Cervico-omo-brachial Syndrome in Our Clinic

In the last 8 years, 1407 patients were diagnosed as cervico-omo-brachial syndrome in our out-patient clinic. We could classify the various disorders considered as a cause of the cervico-omo-brachial syndrome on the basis of the clinical findings, plain and functional radiograms.In these disorders, there are cervical osteochondrosis (subdivided into radicular syndrome and spinal cord compression groups), scalenus anticus syndrome, cervical rib, costo-clavicular syndrome, hyperabduction syndrome, Pancoast tumor and tumors in the cervical spine etc. But in the cases of undetermined cause we classified them as other.342 of 435 patients of cervico-omo-brachial syndrome were of radicular syndrome (79%) and 93 of them of spinal cord compression groups (31%). Others were 922 cases (67%). We discussed each group according to age, sex, occupation, cause, sign and symptoms with their localization, radiological findings and end results.

EFFECT OF SCALENOTOMY IN THE SO-CALLED SCALENUS ANTICUS SYNDROME.

Undoubtedly the Scalenus Anticus Syndrome is a rather confusing term. It is used for a variety of conditions where the main symptoms are neurovascular disturbances in the upper limb. These can be due mainly, or partly and secondarily to pressure effect of the scalenus anterior muscle. The terms cervical rib or costoclavicular syndrome and even brachialgia are used in this connection. They only show thc multiplicity of factors involved. One thing seems to be common to all these conditions. Namely that the main symptoms, pain, paresthesia and muscular weakness, can be cured or markedly relieved by the simple operation of scalenotomy. The purpose of the present investigation is to show the results obtained by scalenotomy in cases where the perplexing condition of the so-called scalenus anticus syndrome was diagnosed or strongly suspected. Two clinical follow-up studies have been published in Finland on this subject (Ahonen and Gylling). Own Material and the Follow-Up Results: The present series consists of all the cases where scalenotomy was performed at the Orthopaedic University Clinic during the years 195163. The total material is 64 cases. The age and sex distribution of the cases will be seen in Table 1. Eight patients are known to be dead, but we have had good information from three of them. Eight patients did not answer the questionnaire. The total material available for follow-up study is therefore 51 cases. The length of the observation period is described in Table 2. This material was divided into four different groups. The first group “excellent” consists of those patients who stated that their symptoms

Roentgenographic Diagnosis of the Neurovascular Compression Syndromes

The occurrence of pain and numbness in the upper extremity frequently lacks satisfactory explanation. The factors responsible for the so-called neurovascular compression syndromes have long been a matter for conjecture and the subject of varying theories. Investigators have gradually defined several well outlined entities according to the causative mechanism, such as the cervical rib syndrome (11), the scalenus anticus syndrome (6), the costoclavicular syndrome (1), the hyperabduction syndrome (12), and the combined shoulder syndromes. The common denominator is pressure on some anatomical segment of the subclavian artery or vein, or the brachial plexus. The most common sites of potential neurovascular obstruction are the intervertebral foramina, the interscalene triangle, the cervical axillary canal, the costoclavicular space, and the region of “scissor-like” encirclement of the axillary artery by the two heads of the median nerve. The symptoms may be aggravated by coexisting dynamic, congenital, traumati...

Some features of the supraclavicular groove.

SummaryThe etiology, pathogenesis, the clinical picture and the diagnostic difficulties of the various supraclavicular groove syndromes, are presented and discussed. Illustrative cases of cervical rib, scalenus anticus syndrome, costoclavicular compression syndrome, and hyperabduction syndrome are reported. The importance of the exact determination of the etiology and of specific treatment is stressed.

Primary subclavian vein occlusion

1. 1. Three cases of acute subclavian vein occlusion are reported. Two developed in patients previously operated upon for carcinoma, but without evidence of metastasis. Changes in anatomic relationships resulting from cutting the pectoralis major and minor muscles may predispose the patient to venous occlusion or a shoulder syndrome. 2. 2. Anterior scalenotomy with the possible aid of severance of the costocoracoid ligament relieved residual symptoms in two cases. 3. 3. An operative venogram with silver clips appropriately placed clearly demonstrated that cutting an enlarged anterior scalene muscle released the pressure on the subclavian vein. 4. 4. Acute subclavian vein occlusion may be considered the venous component of the scalenus anticus syndrome.

Posture and cervicobrachial pain syndromes.

The accurate diagnosis and effective treatment of disabilities manifest by cervicobrachial pain and paresthesias is difficult. The difficulty has been increased by the myriad of reports dealing with cervicobrachial syndromes, because of a tendency to regard each of them as a specific clinical entity. Lack of notable success with specific treatment as in the scalenus anticus syndrome has tended to discredit the syndrome without otherwise accounting for the patient's disability. To fill this void the criteria for a diagnosis of a protruded cervical intervertebral disk are at times stretched beyond their just limits or a functional etiology is invoked to explain such symptoms. To the confusion of examiners, specificity of name in cervicobrachial syndromes is not matched by a specificity of either symptoms or signs. Many of the cervicobrachial syndromes regularly listed in diagnostic classifications are not clinical entities but rather are isolated aspects of a single clinical problem. The

Surgery for cervical rib and scalenus anticus syndrome.

During the last half century scores of papers have been written on pain in the upper extremity, but it is evident that the problem today lacks satisfactory resolution. There is little doubt that in certain instances compression of the neurovascular structures in the neck is due to a cervical rib. Essentially the same symptoms may be present when there is no cervical rib, and numerous authors have believed that the scalenus anterior muscle plays a major role in the production of these symptoms. A review of recent literature indicates growing discord regarding compression of the brachial plexus due to displacement (scalenus anticus syndrome), and many dissent from the idea that the scalenus anterior syndrome without cervical rib is a definite factor in upper extremity pain. In the past 16 years my associates and I have seen 117 patients whose symptoms and signs were such that a diagnosis of cervical rib

Phrenic paralysis following cervical rib resection.

1) Two patients who have had surgery for the scalenus anticus syndrome developed phrenic paralysis subsequent to and apparently as a result of the scalenus anticus operation. 2) This was due, in all probability, to trauma to the phrenic nerve in each case. 3) This condition has apparently not been previously reported.

Brachial plexus irritation due to hypertrophied omohyoid muscle; a case report.

It is recognized that the results of surgery for the scalenus anticus syndrome have, in many cases, been disappointing. It is the purpose of this report to suggest that the possible cause for failure, in some of the patients, may be due to unrecognized pressure on the brachial plexus from either a taut or a hypertrophied lateral belly of the omohyoid muscle. It is not the intention of the author to discuss the scalenus anticus syndrome itself, since the subject has been dealt with exhaustively in the literature. A 30-year-old Caucasian housewife was seen Feb. 8, 1951, complaining of a mass in the left supraclavicular fossa of 10 months' duration. Four months previous to her first visit, while reaching into a deep box with the left arm and turning her head to the right to speak to an acquaintance, she experienced a sudden onset of pain involving the left side

Ruptured cervical intervertebral disks.

Lateral rupture of the cervical intervertebral disks should be considered in the differential diagnosis in a patient with a history of pain or stiffness of the neck, with radiation of pain to the shoulder, arm or hand. In some cases the superficial impression may be that of angina pectoris. Differential diagnosis between cervical rib and scalenus anticus syndrome and cervical disk can usually be made on the basis of the point of reference of pain or numbness. In cases of cervical disk rupture, symptoms and signs are usually referable to the sixth and seventh cervical dermatomes, whereas the other conditions usually involve the eighth dermatome. Roentgenograms of the cervical spine frequently show reversal of the normal curve and narrowing of the suspected interspace.Cervical disks which rupture closer to the midline may produce signs and symptoms of degenerative cord disease, such as amyotrophic lateral sclerosis, or may even cause complete paralysis simulating spinal cord tumor.Because of the great risk ...

Scalenus anticus syndrome caused by trichinosis.

Trichinosis is at least as deserving of the term protean as is syphilis. Since its description by Sir James Paget in 1835, a vast array of signs, symptoms, and disease syndromes have been traced to the presence of the pathogenic Trichinella nematode. The clinical course of trichinous infection is seldom typical, and the diagnosis in sporadic cases is more often established by the pathologist than by the clinician. Hall listed 50 diseases that have been mistakenly diagnosed in patients infected with T. spiralis, 1 and Gould, in his comprehensive monograph, has added many more to this list. 2 For two reasons we wish to report a case of scalenus anticus syndrome caused by trichinosis: 1. To our knowledge this particular syndrome has not been previously reported to result from infestation with trichinae. 2. It seems worthwhile to reemphasize that sporadic trichinosis should be considered in differential diagnosis of any neuromuscular