Anterior scalene syndrome
Introduction
Introduction to anterior scalene syndrome The anterior scalene muscle is located in the deep part of the lateral side of the cervical vertebrae and starts from the anterior nodules of the cervical vertebrae 3-6 transversely, ending at the inner rib cage of the first rib. Anterior scalene muscle syndrome refers to anterior scalene muscle edema caused by various causes, hyperplasia, sputum and lifting of the first rib, leading to stenosis of the scalene muscle, compression of the brachial plexus and subclavian arteries and veins The corresponding clinical symptoms of the disease. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: hand and foot cyanosis muscle atrophy
Cause
Cause of anterior scalene syndrome
The disease is related to the triangular space formed by the oblique muscles of the neurovascular bundle.
Congenital malformation (35%):
The anterior middle scalene muscles merge into one piece, so the brachial plexus must be opened before the fibers of the middle scalene muscle pass. The patient generally presents underdeveloped muscles with a sagging shoulder and a scapula, and the symptoms vary depending on the tissue being compressed.
Anterior scale muscle hypertrophy (25%):
The anterior scalene muscle is located in the deep part of the lateral side of the cervical vertebrae and starts from the anterior nodules of the cervical vertebrae 3-6 transversely, ending at the inner rib cage of the first rib. It may be primary or it may be a anterior scalene tendon that is secondary to stimulation of the brachial plexus.
The attachment point of the anterior scalene muscle causes the narrowing of the triangular gap.
In all three cases, the neurovascular bundle can be compressed to produce the scalene syndrome.
Prevention
Anterior scalene syndrome prevention
With the development of society, the number of people engaged in computer and secretarial work has gradually increased. This has led to an increase in the incidence of strains of soft tissue strains. Therefore, it is necessary to pay attention to the combination of work and rest in daily life, and exercise more appropriate rest for physical exercise. The occurrence of strain-related disorders.
Complication
Complications of anterior scalene syndrome Complications, hand, foot and hair disease, muscle atrophy
This disease can cause vascular symptoms on the affected side. The upper limbs or fingers are cold, cyanosis or pale, with the most obvious hand, more obvious when drooping, weakened pulse on the affected side, decompression of blood pressure, and necrosis of fingertips in severe cases. Spotted ecchymosis, etc., long-term patients, small muscles in the affected area and hand atrophy, weak grip.
Symptom
Symptoms of anterior scalene syndrome Common symptoms Thumb and index finger can't... The muscles of the sagging shoulder and shoulder strap are underdeveloped. The little finger feels the pain of the forearm and wrist.
The anterior scalene symptom group occurs in middle-aged people, more women than men, and the right side is more than the left side. The patient generally has muscles that are sagging shoulders and shoulder straps, and the symptoms are different due to the compressed tissue.
1. Subclavian artery compression
The pain is ischemic jumping pain, the onset can be sudden, accompanied by soreness and discomfort, starting from the neck to the hands and fingers, with numbness and tingling, the pain site has no clear boundaries, cervical activity It can aggravate the pain. When the neck is straight, the scalene muscle space becomes smaller and the pain is aggravated. The neck flexion can increase the space between the scalene muscles, and the pain can be relieved. Pulling the affected limb to lower the shoulder blades can aggravate the symptoms.
2. Brachial plexus compression
This condition occurs in long-term lesions, underlying dryness of the brachial plexus, which is acute pain and radiates from the inside of the forearm and 4,5 fingers.
3. The subclavian artery and brachial plexus are simultaneously compressed
This condition is the same as the symptoms of the neck rib. The patient usually supports the head with his hand to tilt it to the affected side, thereby relieving the tension of the anterior scalene muscle. The supraclavicular fossa can be paralyzed and the anterior scalene muscle is tense, tender, and oppressed. Muscles cause severe tenderness and radiation pain. The neck stretches and aggravates pain. Sometimes allergies and coldness appear in the hands, and movement disorders and reflexes disappear.
Examine
Examination of anterior scalene syndrome
The auxiliary examination methods for this disease mainly include X-ray examination, angiography and CT examination.
1, X-ray films can be used to rule out the deformity of the cervical and thoracic vertebrae - such as the neck rib or the first rib abnormalities.
2, angiography is valuable for the diagnosis of this disease, this method can also be used to locate the compression of the subclavian artery.
3, CT examination: CT can be seen due to muscle cell hypertrophy caused by increased cross-sectional area; muscle fiber proliferation can lead to increased local density, CT value; when attached to the surrounding tissue, the CT film shows the front bevel muscle and surrounding tissue boundaries clear.
Diagnosis
Diagnosis and differentiation of anterior scalene muscle syndrome
diagnosis
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis
The anterior scalene muscle syndrome belongs to the category of brachial plexus upper extremity pain and vascular disorders and needs to be identified with the following diseases:
1, nerve root type cervical spondylosis
The painful nature is rooted neuralgia, which is lightning-like radiation, and is consistent with the distribution of nerve roots. The tender points are mostly in the affected neck and neck joints, X-ray shows cervical vertebra hyperplasia, vertebral joint dislocation, and the Addison test is negative.
2, small chest muscle syndrome
Let the patient do chest muscle contraction, or excessive abduction of the upper limbs, do the resistance of the affected limb, check the symptoms, the pulse may be weakened or disappeared. After changing the position of the shoulder arm, the symptoms are relieved, and the tender point is at the condyle.
3, cervical syndrome
Also known as cervical spondylosis, it is a slow-moving degenerative disease, more common in middle-aged and elderly people. According to clinical symptoms and X-ray or CT, MRI examination, cervical spondylosis can be divided into nerve root type, vertebral artery type, cross nerve type and Spinal cord type IV, the cervical vertebrae are in flexion position or certain specific positions for a long time, which not only increases the pressure in the cervical intervertebral disc, but also causes the neck muscles to be in an uncoordinated state for a long time. The posterior neck muscles and ligaments are easily pulled. Strain injury is prone to cervical spondylosis.
