Thoracic Outlet Syndrome From Scalene Muscle Entrapment

Anterior scalene syndrome is one of the subcategories of thoracic outlet syndrome. Anterior scalene syndrome is often misdiagnosed by patients when they google their condition.  Most web searches reveal more common and talked about compression syndromes, such as carpal tunnel.  The location and symptoms of hand pain and weakness are different in thoracic outlet syndrome and carpal tunnel because different tissues and nerves are compressed.   The brachial plexus and subclavian artery can be compressed as it passes between the anterior and medial scalene muscles near the first rib, resulting in pain, numbness, tingling, or weakness in the upper arm, elbow, forearm, hand, or finger tips.


The scalene muscles are deep neck flexors that help stabilize the spine during normal movements and lift the rib cage while taking a breath.  These muscles are traveling from the neck down towards the rib cage. The brachial plexus and subclavian artery travel between the scalene muscles as it exits the neck and heads down the arm. The subclavian artery will provide blood flow down the arm, while the brachial plexus is composed of nerves from C5 – T1. This nerve is what innervate muscles and sensory for the entire arm.


Who Develops Scalene Syndrome?


Any activity that causes muscle spasms of the scalenes can lead to anterior scalene syndrome. It is very common in people with a head forward and down activities, such as working at a computer for a prolonged amount of time. People who have that head forward and shoulder-rounded posture are more likely to be affected by this condition because of the chronic shortening of the scalene muscles. It can be caused by either acute or chronic trauma, such as whiplash or falls.  It is also very common with prolonged work above the head, chronically carrying bags on one shoulder, or advanced aged.


The complication of diagnosing anterior scalene syndrome is related to the number of nerves that can be affected, and the variability with positions and blood flow. Symptoms often change depending on the amount and forcefulness of activity. Pain and tingling with prolonged positions and postures also fluctuate when trying to reproduce the condition in the office.


Symptoms of TOS


Pain can occur anywhere along the arm, but most commonly starts in the fingers or hand. Numbness is most common in the fingers, hand and forearm. Some patients describe feeling cold in the hand and forearm. Others describe numbness and weakness; or a smaller percentage describe skin color changes. Many people notice their weakness or clumsiness increases with repetitive activity, especially above the head.


In some cases, weakness and atrophy of the hand or forearm muscles can occur. Some people describe sensation changes just at the fingertips. Orthopedic testing and evaluation often produces false positive and false negative signs. Any test that stretches the scalene muscles and further compresses the subclavian artery and brachial plexus will reproduces symptoms, while relaxing the muscles and opening the pathway often decreases symptoms. In its early stages it can be difficult to differentiate with testing. Many times patients describe increased pain, numbness, or tingling after one to two hours of activity. As a condition worsens, the time needed to trigger the symptoms decreases. Eventually the pain can occur with just a few moments of activity, especially above the head.


 Treatment for Thoracic Outlet Syndrome


Treatment involves decreasing muscle spasms, hypertrophy, inflammation and fascial irritation along the scalene muscles. Massage therapy is an excellent treatment for decreasing the muscle spasms and tension across the scalene muscles, neck muscles, trapezius, Pectoralis major, and pectoralis minor muscles that often accompany scalene syndrome. Manual therapy and physical therapy can also enhance the treatment by increasing muscle flexibility and decreasing pain. Treatment modalities may be utilized to increase blood flow and decrease inflammation to the muscles, tendons, and soft tissue of the neck. Graston Technique and Active Release Technique (ART) are also used for treatment.


The treatment goals are to decrease muscle spasms and inflammation; which is why class IV K cold laser is an excellent treatment modality for enhancing recovery from anterior scalene syndrome. Cold laser is an excellent tool at decreasing inflammation in the deep muscles and tendons. It also increases blood flow to the injured muscles, fascia, and nerves to speed their recovery. Class IV K laser is excellent at increasing cellular and metabolic activities that will speed nerve and muscle cell regeneration (More information on How Lasers Work).


Treatments goals are to enhance repair, decrease inflammation, and increase blood flow are enhanced when a class IV K cold laser is incorporated into the treatment plan. Patient’s overall recovery time will be decreased along with their intensity, frequency and duration of symptoms in their arm and hand.

If you are suffering from anterior scalene syndrome, consider class IV K cold laser as a treatment modality to enhance your healing and treatment. 

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