Scalene muscle syndrome - causes, symptoms, treatment of scalene muscle syndrome in Moscow at the Spina Zdorova clinic

Description of the pathology. Pathogenesis

Scalenus syndrome is caused by the anatomy of this location. Having learned the details, you will immediately understand who is to blame and what to do?

The scalene muscles are located vertically along the spine. With their upper ends they are attached to the sides of the vertebrae, and with their lower ends they are attached to the two upper ribs, which are located in the uppermost part of the chest, deep behind the collarbone. It is here, above and behind the collarbone, at the border of the neck and chest, that the anterior scalene muscle syndrome develops. The scalene muscles owe their name to their peculiar arrangement - ledges. If a person were lying on his back, the muscles would look like steps. The bottom step is the posterior scalene muscle, the second is the middle step, and the topmost step is the anterior scalene muscle. This is exactly how ancient Roman anatomists saw these muscles and gave them the appropriate name.

Between the anterior and middle scalene muscles are the subclavian artery and nerves that run from the spine to the arm. And although it is quite narrow here, like tunnels, if the muscles are healthy, then the nerves and arteries are not in danger. Firstly, because healthy muscles are elastic and soft, and secondly, both the muscles themselves and the nerves with the artery are covered with a dense slippery membrane - fascia. This ensures they slide smoothly relative to each other and protects them from any pinching when moving the head and neck. However, with pathology, everything changes - the anterior scalene muscle spasms and its tone increases sharply. This causes pain and, in addition, a muscle that is stretched like a string can squeeze the nerves and arteries in the narrow tunnel that we talked about above.

Thus, with anterior scalene muscle syndrome, the patient will experience one of two possible options for the development of this pathology. The first one is relatively easy. It causes muscular-tonic (myofascial) syndrome. Trigger points appear in the muscle, triggering referred pain in the neck, shoulder, chest, shoulder blade and arm. The second one is more difficult. Here the spasmed muscle pinches a nerve or vessel. In this case, in addition to pain, neurovascular pathology also occurs, or, as they say in medicine, neurovascular pathology. By the way, anterior scalene muscle syndrome is the most common neurovascular pathology of the neck. It is also called scalenus syndrome or Naffziger syndrome.

For reference: scalenus – staircase (latin). Howard Christian Naffziger is an American neurosurgeon who was one of the first to describe neurovascular pathology caused by the anterior scalene muscle.

Meningeal syndrome

Meningeal syndrome is formed by signs of irritation of the meninges due to their inflammation or subarachnoid hemorrhage. The term meningism (Dupre E., 1895) refers to symptoms of irritation of the meninges that occur during intoxication, metabolic disorders, some general infections, cerebral edema and hydrocephalus, but there are no signs of inflammation of the meninges and the presence of blood in the cerebrospinal fluid. With meningism, unlike meningitis, inflammatory changes in the cerebrospinal fluid are not detected.

The main, most constant and informative signs of irritation of the meninges are stiffness of the neck muscles and Kernig's sign. A number of other symptoms also have diagnostic significance.

1) Rigidity (lat. rigidus - hard, hard) of the occipital muscles is a consequence of a reflex increase in muscle tone of the head extensor muscles. When passively flexing the head of a patient lying on his back, this cannot be done due to involuntary muscle resistance. In this case, the patient's upper body may involuntarily rise. Thanks to muscle protection, headaches, inevitable with meningitis, do not get worse when moving the head.

Rigidity of the neck muscles can also occur with severe parkinsonism syndrome, along with other manifestations of the latter (akinesia, bradykinesia, oligokinesia, hypokinesia, lack of conjugal movements, increased muscle tone of the extrapyramidal type - mainly in the flexor muscles and with the “cogwheel” phenomenon during passive flexion of limbs, microbasia, micrographia, tremor, “petitioner” pose, shuffling “doll” gait - feet are placed parallel when walking).

It should also be noted that limited mobility in the cervical spine in elderly patients may be a consequence of osteochondrosis, paratonia (impaired muscle tone in the back of the head, not associated with parkinsonism). In contrast to these conditions, with meningitis, only flexion of the head is difficult, but not its rotation or extension.

2) Kernig’s sign (1882) – a reflexive defensive reaction in response to extension of the leg at the knee joint in a patient lying on his back. With meningitis, the symptom is positive on both sides (if the patient does not have hemiparesis). The symptom can also be positive in elderly patients if they have muscle rigidity (this symptom was allegedly first described in 1810 by medical student H. Strong).

3) The “pointing dog” or “cocked gun” pose - the patient lies on his side with his head thrown back and legs pulled up to his stomach, arching his body forward (meaning opisthotonus - tonic contraction of the spinal extensor muscles; Greek opisthen - behind, back; tonos – tension). The arms are bent at the elbow joints. There may be trismus (Greek trismos - clenching of the jaws) - tonic tension of the masticatory muscles.

4) Headaches of a diffuse nature, aggravated by exposure to external sensory stimuli.

5) Vomiting – more often than not, vomiting is preceded by nausea, but this does not always happen. Vomiting is not associated with the intake of food, liquid or medication, it is profuse and often repeated, and does not bring relief. It occurs due to direct irritation of the nuclei and fibers of the vagus nerve.

6) Sensory hyperesthesia - hypersensitivity to light, sounds, touching the skin and mucous membranes, and other external and internal sensory stimuli, which usually increase the intensity of the headache due to the irradiation of excitation to the nuclei of the cranial nerves, the receptors of which are scattered in the meninges and blood vessels of the brain. When tapping, for example, with a hammer on the zygomatic bone, a grimace of pain appears on the patient’s face - Bekhterev’s symptom, and percussion of the frontal bone causes increased headache and shuddering - Lichtenstern’s symptom. Children become capricious and resist examination - it increases their suffering.

7) Symptom of Lesage hanging - if a child of the first years of life is taken under the arms and raised above the bed, he pulls his legs to his stomach and fixes them in this position (a healthy child minces his legs, he seems to be looking for support).

Meningeal potty symptom - when a child with meningitis sits on the potty, he tends to rest his hands on the floor behind his back.

9) Symptom of kissing the knee - with irritation of the meninges, a patient with meningitis cannot, due to increased headaches, touch his knee with his lips.

10) Brudzinski’s meningeal symptoms - there are four of them: a) cervical symptom - when pressing on the cheek under the zygomatic arch on the same side, the shoulder girdle is raised and the arm bends at the elbow joint; b) upper symptom - when trying to bend the head of a patient lying on his back, his legs involuntarily bend at the hip and knee joints, pulling towards the stomach; c) middle or pubic symptom - when pressing on the pubis of a patient lying on his back, his legs bend at the hip and knee joints and are pulled towards the stomach; d) lower symptom - when trying to straighten the leg of a patient lying on his back, bent at the knee joint, he reflexively pulls the other leg towards his stomach.

11) The symptom of a scaphoid abdomen is tension in the abdominal muscles, resulting in a retracted abdomen. It is often detected in children suffering, in particular, from tuberculous meningitis.

12) There are often signs of damage to the cranial nerves, in particular strabismus, double vision, decreased visual acuity, tinnitus, etc.

13) Inflammatory changes in the cerebrospinal fluid - pleocytosis, or an increase in the number of leukocytes in purulent meningitis, lymphocytes - in serous meningitis and at the same time, but to a lesser extent, an increase in the amount of protein in the cerebrospinal fluid (cell-protein dissociation; in tumors the ratio is often the opposite - protein-cell dissociation ). In case of immunodeficiency, the only sign may be a change in the content of only protein and glucose in the cerebrospinal fluid. Neutrophilic pleocytosis and a significant increase in protein levels are considered a poor prognostic sign of meningitis.

14. Autonomic symptoms - increased body temperature, slow pulse, hyperhidrosis, hypersalivation, breathing problems, etc. Children with meningitis often experience drowsiness, progressive weight loss and cardiac arrhythmias - Lesage-Abram's symptom.

Return to Contents

Symptoms of the syndrome

As mentioned above, the symptoms of anterior scalene muscle syndrome can be either purely painful, due to muscle spasm, or neurovascular disorders are also added to the pain, due to compression of the nerves and subclavian artery.

Pain is the first and most debilitating symptom

; it extends from the shoulder joint down the arm and can extend to the little and ring fingers. Sometimes the pain moves to the chest or back of the head. The pain often worsens at night. The pain also intensifies when turning the head, when moving the arm to the side and when taking a deep breath. The scalene muscles are accessory muscles of inspiration. When you inhale deeply, they contract and pull the upper ribs and chest upward. This causes the chest to rise and more air to enter the lungs. This is why anterior scalene muscle syndrome often develops, due to its prolonged overload, in people suffering from shortness of breath or some diseases of the respiratory system, for example, colds. By the way, not only shortness of breath or a cold can cause muscle strain. There is a so-called hyperventilation syndrome, when diaphragmatic breathing is impaired against the background of psychosomatic, anxiety or psychovegetative disorders. In these cases, the auxiliary respiratory muscles, primarily the scalene muscles, are forced to completely take over the performance of respiratory movements. This is an excessive burden for them, a cause of overexertion and the starting point for the development of anterior scalene syndrome.

Second group

symptoms of anterior scalene muscle syndrome are manifested by sensations of tension in the neck muscles, heaviness, numbness and weakness in the arm, up to severe paresis (incomplete paralysis) of the hand and muscle atrophy. However, it should be noted that paresis and atrophy of the hand are extremely rare - only in very advanced cases.

Third group

– vascular symptoms of anterior scalene muscle syndrome: swelling of the arm, its cyanosis, coldness, weakening of the pulse, up to its complete disappearance when raising the arm up or tilting and turning the head. In addition to the subclavian artery, lymphatic vessels are often affected. Their clamp disrupts lymph circulation. This leads to stagnation and edema, which manifests itself as swelling in the supraclavicular fossa (Kovtunovich's pseudotumor).

And the fourth group

– vegetative-trophic symptoms of the anterior scalene muscle syndrome are manifested by brittle nails and a decrease in hair on the arm. However, the manifestation of vegetative symptoms, too, is noted only against the background of long-term and advanced cases, which, fortunately, does not happen often. A modern person, especially one living in a large city, will rarely wait until such a stage to see a doctor.

Other meningeal signs

The following important symptoms of meningitis are common to adults and children:

Kernig's syndrome . It consists in the fact that the subject cannot straighten the leg at the knee if it is already bent at the hip joint.
Flatau reflex . With a sharp passive (by the doctor’s hand) flexion of the patient’s neck, the pupils dilate.
Hermann's sign . While the doctor presses the patient's head to the chest, the patient's big toes extend.
Mondonesi syndrome . When pressing on the eyeballs through closed eyelids, the examined patient feels pain, and this is a sign of meningitis.
Matseven's symptom - a specific “sound of a cracked pot” is heard when examining the skull with a finger or a percussion hammer.

All these symptoms and specific reflexes are included in the meningeal symptom complex.

What happens if you trigger scalene syndrome?

The most dangerous complication of anterior scalene muscle syndrome is thrombosis in the subclavian artery system. For a better understanding, it must be said that the vertebral arteries depart from the left and right subclavian arteries, from which, in turn, the arteries of the brain begin. Thrombosis in this system is a truly deadly complication of anterior scalene syndrome and requires immediate surgical intervention.

The second serious complication is paresis (incomplete paralysis) and atrophy of the hand muscles.

Another striking and unpleasant complication is a violation of the biomechanics of the neck and body as a whole. This point is a little difficult to understand for a non-specialist, but now we will understand it. So. With prolonged tension of the scalene muscles, they shorten. This increases cervical lordosis and moves the head forward. To compensate for balance and center of gravity, the muscles in the back of the neck are forced to tighten and, accordingly, overload. Soon, due to overload, secondary pain trigger points will form in the back muscles of the neck, and myofascial syndrome will develop. Further, if left untreated, increased cervical lordosis will lead to compensatory curvature of the spine in the thoracic and lumbar regions, because it is forced to seek balance. Curvature of the spine disrupts the distribution of axial loads on the intervertebral discs and, thus, opens the way to the formation of protrusions and disc herniations not only in the neck, but also in any other compensatory overloaded place in the spine.

Myofascial scalene syndrome

That is why timely consultation with a doctor, early detection and proper treatment can avoid all these serious complications of anterior scalene syndrome.

Complications

For a long time, some patients reflexively react to pain with muscle fixation. They have to hold a rigid certain position in order to reduce pain. But, unfortunately, this reflex muscle defense aggravates the course of the disease and, ultimately, leads to increased pain. Muscle defence, in turn, then requires separate treatment. It is important to begin treatment for SLM in its early stages. If left untreated, SLM can cause significant nerve or vascular damage, including limb loss.

Diagnostics

Diagnosis of anterior scalene syndrome is based on a typical clinical picture and always begins with an examination. During such an examination, most patients will experience swelling in the supraclavicular region. This is the so-called pseudotumor (pseudotumor) of Kovtunovich. It occurs due to compression of the lymphatic vessels by the anterior scalene muscle. Also, during the examination, pay attention to the hand - it may be swollen and slightly bluish. In advanced cases, more pronounced changes will be noted, even trophic ones.

When palpating the anterior scalene muscle, it will be sharply tense and painful, and this will also cause increased pain in the neck with possible spread to the arm.

Neurological examination - checking sensitivity, reflexes, etc. - identifies sensory, motor and autonomic disorders.

Spasm test. It is carried out to identify myofascial syndrome of the scalene muscles. You need to turn your head as far as possible in the painful direction and firmly press your chin to your collarbone. The scalene muscles will contract and trigger points in them will be activated. As a result, the patient will feel increased pain.

Adson's test: if you raise your arm on the side of the anterior scalene muscle syndrome and tilt your head here, then where you usually check the pulse at the wrist, there will be no pulse.

Doppler ultrasound (USD) of the neck vessels also has a certain diagnostic value, especially taking into account that the vertebral artery, which supplies the back of the brain, departs from the subclavian artery. And this entire vascular network may suffer from compression of the subclavian artery, which in turn threatens cerebrovascular accident or thrombosis.

Electroneuromyography (ENMG) is considered a generally accepted diagnostic method. Although, at the initial stages of pathology, its information content is not high enough, and sometimes even fraught with erroneous conclusions.

Therefore, the best test for all stages of anterior scalene syndrome is good old manual muscle testing.

Undergo a comprehensive diagnostics of the scalene muscles. We will conduct palpation, neurological examination, spasm test, Adson test and manual muscle testing: we will test the muscles for the presence of active and latent trigger points.
Diagnostic duration is 30 minutes. This is a full-fledged examination, and not a 2-minute “feeling” for show.
The diagnosis is carried out personally by Dr. Vlasenko A.A., a doctor with 30 years of experience, an expert in the treatment of myofascial and radicular syndromes.

Dr. Vlasenko Alexander Adolfovich, neurologist, manual therapy doctor

Symptoms

Symptoms of SLM vary depending on whether the blood vessels or nerves are compressed.

Symptoms of nerve compression

Pain or tenderness in the neck, shoulder, arm
Numbness or tingling in the neck, shoulder, arm
Muscle weakness or areas of muscle failure in the arm
Difficulty performing fine motor tasks; fast fatiguability

Arterial Compression Symptoms

Swelling of the hand
Pain or deep tenderness in the neck, shoulder, or arm
Numbness, tingling, or heaviness in the arm
Changes in skin color - the hand or fingers turn pale
Changes in skin temperature – the arm or fingers are cooler than the rest of the skin
Small black spots on fingers
Weak or absent pulse in the arm
Pulsating tumor in the collarbone area

Venous Compression Symptoms

Swelling of the hand
Pain or deep tenderness in the neck, shoulder, or arm
Numbness, tingling, or heaviness in the arm
Changes in skin color - the hand or fingers become blue
Seal in the area of the subclavian vein
Visually noticeable venous network on the chest.

Treatment of scalene syndrome

Effective treatment of scalene muscle syndrome requires a clear understanding of the cause and mechanism of the disease, as well as an integrated approach to treatment.

For the treatment of anterior scalene muscle syndrome, the following are used: drug treatment, physiotherapy, exercise therapy, massage, surgical methods and manual therapy. Of course, one should start with conservative methods, among which manual therapy occupies a key place. But first things first.

Manual therapy

Don't think that manual therapy for scalene muscle syndrome means realigning the vertebrae or anything like that. If you thought so, you were deeply mistaken. Modern gentle manual therapy is a set of methods aimed at eliminating pain, normalizing muscle tone and restoring the full range of movements of the affected region and the entire musculoskeletal system as a whole.

All methods of manual therapy for scalene muscle syndrome can be divided into direct and indirect; active and passive; soft and trusting. But, one way or another, the main part consists of the so-called neuromuscular methods, in which the impact occurs through soft tissues: muscles, fascia, etc.

In manual therapy of scalene muscle syndrome, neuromuscular methods are mainly used. They include: post-isometric relaxation, reciprocal inhibition, isotonic concentric and eccentric contractions, positional relaxation techniques, strain-counter-strain, myofascial release, etc. As well as direct manual methods: ischemic compression, pressure on trigger points, acupressure, transverse friction, soft tissue mobilization, deep tissue massage, etc.

Correct and adequate use of all these numerous soft methods gives an amazing therapeutic effect in manual therapy of scalene muscle syndrome.

Advantages of treatment at the Spina Zdorova clinic

Guarantee of complete and qualified treatment. The word “full” is key in our work.
High qualifications and extensive practical experience - 30 years.
We consider each case individually and comprehensively - no formalism.
Synergy effect.
Guaranteed fair treatment and fair price.
The location is a stone's throw from the metro in the very center of Moscow.

Other methods of treatment. Physiotherapy

Physical therapy for scalene syndrome is a supportive treatment. The most commonly chosen procedures are:

Sinusoidal modulated currents (SMC) or – second name – amplipulse therapy. This procedure perfectly copes with pain and muscle spasms, while simultaneously restoring their blood supply and nutrition.

Electrophoresis is a classic of physiotherapy. A less powerful, but gentler method of treatment. Suitable where there are contraindications for SMT therapy.

Ultrasound (UT) is, in fact, a micromassage. Propagating deep into the tissue, ultrasound transmits its vibrations to these tissues, thereby improving their drainage and trophic functions. Deep swelling, stagnation and inflammation disappear, blood circulation and tissue nutrition are normalized. Due to this, the pain syndrome is reduced.

Magnetotherapy – increases microcirculation, thereby eliminating congestion, swelling, inflammation and reducing pain.

Surgical treatment

Surgical treatment of scalene muscle syndrome is used only in advanced cases of the neurovascular stage of the syndrome, when compression of the nerves and subclavian artery could not be eliminated by other means. As we said above, conservative treatment is not always able to solve the problem, and then surgery becomes the only option.

During surgical treatment of scalene muscle syndrome, the muscle itself and adjacent tissues compressing the nerve and artery are dissected. To prevent relapses, muscle resection is carried out over as large an area as possible.

Once again, we draw your attention to the fact that it is advisable to consider the issue of surgical treatment of scalene muscle syndrome only when all conservative treatment methods have been completely exhausted.

Don't let your illness get worse! Timely consultation with a doctor allows you to avoid surgery!

Prevention

Prevention of scalene muscle syndrome is aimed at preventing the circumstances that lead to the occurrence of the syndrome. What are these circumstances?

Firstly, scalene muscle syndrome very often occurs as one of the links in the pathology of the intervertebral discs of the cervical spine. Therefore, timely consultation with a doctor and elimination of any pathology of the spine and discs in the early stages is the most important preventive action.

Secondly, since the main provoking factor in the development of the syndrome is prolonged forced positioning of the head and arms, which usually happens during sedentary work, it means that it is necessary to take regular breaks. Keep in mind that the optimal time for continuous work is 45 minutes, like a school lesson (plus or minus 15 minutes). In other words, try to change your body position - it doesn’t matter how exactly - get up, stretch, walk - the main thing is to make a short-term change in position. In general, approach this issue creatively and act according to the circumstances.

Thirdly, very often scalene muscle syndrome occurs against the background of sports overtraining, so people who are actively involved in sports need to be aware of this and be attentive to the signals of their body.

In general, this wish is not only for lovers of an active life, but for everyone - do not ignore “body language”, because many problems arise from neglecting these signals. As practice shows, almost all patients who consult a doctor with scalene muscle syndrome describe the onset of the disease in the same way: “It all started a long time ago and at first it didn’t bother me much.” This is a classic onset - gradual and not very painful. This is how the body sends us signals, giving us the opportunity to quickly correct everything. And we jam the signals with analgins, thinking that “everything will resolve itself.” Alas, this is not true. From a certain point, the disease will rush like a rapid avalanche, and it will be very difficult to stop it and eliminate the consequences. Therefore, we draw your attention once again - do not ignore “body signals”, do not let yourself go and do not bring the situation to a crisis.