Ladder muscle syndrome

Scalene muscle syndrome is a set of symptoms that include a feeling of compaction or thickening in the anterior scalene muscle, as well as its spasm. In addition, there is secondary compression of the bundle of nerves and vessels (this complex includes a bundle of C8-T1 roots in the shoulder and an artery with a vein located under the collarbone) in the space between the rib and the muscle mentioned above.

[ 1 ], [ 2 ]

Causes ladder muscle syndrome

Often, problems with the anterior scalene muscle begin due to the development of osteochondrosis of the thoracic spine and neck. Sometimes the syndrome can form due to abnormal placement of the ribs of the neck or some kind of injury. The disorder often develops in teenagers who are actively involved in sports, because the muscles are subject to constant trauma - the skeleton grows at an accelerated pace and receives great physical loads.

The cause of the anterior scalene muscle syndrome is usually the irritation of the sympathetic fibers, as well as the C6-C7 roots. Similar manifestations can be observed during osteochondrosis of the neck. A characteristic sign of the syndrome is considered to be pain in the neck, which spreads along the elbow part of the arm. The development of the disorder can lead to hypotrophy of the wrist muscles, in which the arm loses sensitivity and goes numb - this is similar in its symptoms to Raynaud's disease, in which swelling of the hand appears, the pulse located on the radial artery weakens, and ischemic crises provoked by cold appear.

[ 3 ], [ 4 ]

Pathogenesis

Scalene muscle syndrome is characterized by pain that begins in the shoulder and cervical region, descending down the ulnar part of the arm. Such sensations make patients complain that they are unable to work with their arms raised up or lift any heavy objects at all. The pain intensifies if you start moving your neck, arms and torso, as well as when turning your head. Along with this, your head may hurt, and paresthesia may appear in the arm. The head may hurt due to the occurrence of vertebrobasilar insufficiency and compression of the spinal artery. In addition, the cause may be the transfer of pain impulses from the shoulder to the neck.

There is an opinion that, most likely, there is a combination of scapulohumeral pathology, which appeared as a result of myofascial and muscular-tonic syndromes of the shoulder girdle and motor disorders in the cervical spine.

It is also necessary to take into account other factors of pain in the shoulder and neck, as well as problems with their motor functions, which have different pathogenesis. Among such causes are various disorders in the brachial plexus and individual bundles of nerves and vessels, which often occur with the progression of destructive and degenerative processes or tunnel syndromes. They appear against the background of vascular diseases leading to local hemodynamic disorders, and neoplastic processes.

[ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]

Symptoms ladder muscle syndrome

Scalene muscle syndrome manifests itself as pain spreading from the shoulder to 4-5 fingers, and in addition as loss of sensitivity of the limb. Sometimes the pain can spread to the back of the head, especially when turning the head, and move to the sternum, as with angina.

As the disease progresses, the blood supply to the pulse decreases, as well as the arterial pressure in the limb. Cyanosis appears, the arm itself begins to go numb under the compression site. When examined by palpation, tension is felt in the anterior muscle.

With prolonged and constant disruption of blood flow in a muscular organ, connective tissue transformations begin, which are already an irreversible process.

A symptom of scalene muscle syndrome may be a reflex pain spasm, which appears as a result of the effect on the roots provoked by cervical osteochondrosis. The anterior muscle is located between the fibers of the 3rd-6th vertebrae (located transversely) and the first upper rib. Due to the contracture of the muscle, the artery located under the collarbone and the lower part of the plexus (shoulder), located between it and the rib, are strongly compressed.

It is very important to distinguish the manifestations of the anterior scalene muscle syndrome from the similar Pancoast syndrome - a malignant neoplasm of the apex of the lung.

First signs

Scalene muscle syndrome is detected as severe pain in the neck, which is especially noticeable when the head is turned to the healthy side. If the head is slightly tilted forward to the sore side, the pain from the neck along the inner shoulder side, as well as the forearm, will reach the wrist and further to the fingers. Also, in this area, due to the disorder, atrophy and weakening of the interosseous muscles, long finger flexors and muscles of the big toe may develop.

When the artery under the collarbone and the periarterial bundle are compressed, the first signs usually include a weakening of the pulse located on the radial artery. In addition, the hand swells, and ischemic crises with an intermittent reaction begin to appear, in which the fingers turn pale and hurt, resembling the so-called Raynaud's disease.

It should be taken into account that with optimal physiological and physical parameters, an arm bent at the elbow and pulled back by 45-180° will lead to a weakening or complete disappearance of the pulsation on the radial artery. Since the anterior muscle, as an auxiliary one, lifts the 1st rib on inhalation, deep inhalation of air can cause a rather sharp pain in the arm.

[ 10 ], [ 11 ]

Complications and consequences

Among the consequences and complications, it is noted that with this syndrome, the reaction to pain will be a long-term fixation of the muscles, which occurs completely reflexively. They have to maintain the pose until the pain subsides. But such a reflexive protective reaction will only increase the painful sensations and contribute to the development of the disease.

Due to muscle defense, it is necessary to conduct another course of treatment later, separate from the main one. It is very important not to miss the onset of the syndrome, detecting and starting treatment at the very initial stage. In the absence of due attention and treatment, the scalene muscle syndrome can cause tissue trauma in the vessels, as well as nerve fibers, which may even require amputation of the arm in the future.

[ 12 ], [ 13 ], [ 14 ], [ 15 ], [ 16 ], [ 17 ]

Diagnostics ladder muscle syndrome

Diagnosis of scalene muscle syndrome is quite a difficult task. The signs in their expressiveness and character depend very much on the individual characteristics of a person. In addition, many symptoms are similar to those that appear in other diseases. For example, these can be diseases such as disorders in the cervical spine, due to which the roots are compressed, as well as rotator cuff injury. Thanks to a physical examination and medical history, it is possible to find out when the disease began, learn the characteristics of the symptoms and how they depend on the position of the body.

There are also some external signs indicating the presence of the syndrome - the hand swells, changes color and becomes insensitive. Also, the shoulder becomes limited in range of motion. During a physical examination, the doctor performs procedures that allow identifying other symptoms - finds out the level of pulse pressure in the hands (healthy and sick) with their different positions.

The doctor diagnoses the scalene muscle syndrome based on the symptoms that appear during the examination. With certain movements of the neck and arm, a pinching pain may appear and the pulse may disappear. When diagnosing the syndrome, the following procedures are performed: electromyogram, as well as angiogram. They allow you to examine the compressed part of the blood vessels.

[ 18 ], [ 19 ], [ 20 ]

Tests

Scalene muscle syndrome can be diagnosed based on laboratory test data. For this, patients undergo various blood tests - general, sugar and hormone tests, as well as urine tests.

[ 21 ], [ 22 ], [ 23 ], [ 24 ]

Instrumental diagnostics

The following methods are used for instrumental diagnostics of this disease.

• Electromyography, which allows you to find out how muscles and nerves work - small needle electrodes are inserted into the damaged muscle, and they measure its electrical activity at the moment when it is innervated by a nerve. The pathological muscle reaction shows the state of the nerve that is connected to this muscle.

In addition, EMG makes it possible to find out the speed of impulse passage through a nerve ending. The procedure is carried out by placing electrodes on the skin. The speed of impulse passage through each nerve ending has a specific average value, so any deviation from it will mean the presence of a disorder in it.

X-rays can reveal changes in the bones of the ribs and chest.

• To examine the blood circulation in the arm, ultrasound is used (this procedure is also called Doppler vascular scanning).
• Using MRI, it is possible to identify the reason why a vessel or nerve is being compressed.
• Computed tomography makes it possible to track changes occurring in bone tissue.
• Ultrasound visualizes blood vessels (arteries and veins) to detect the presence of blood clots.
• Angiography, in which veins and arteries are checked for blood clots and other problems in the circulatory system.

All this helps to diagnose scalene muscle syndrome.

Differential diagnosis

Scalene muscle syndrome is classified as a tunnel syndrome. The main cause of its occurrence is considered to be osteochondrosis of the spine, in which irritation of the 3-7 cervical roots is observed. The causes can also be muscle strain, the presence of a cervical rib, instability of the cervical vertebrae, due to which myofasciopathy of the scalene muscles (middle and anterior) develops.

To help differentiate this syndrome from other diseases, clinical examination is used, as well as other procedures, including methods such as thermovisiography, electroneuromyography, X-rays and, in some cases, computed tomography.

Differential diagnosis is carried out using a clinical examination: palpation of the neck reveals unilateral swelling, thickening of the left or right muscle, as well as painful sensations in them.

To clarify the diagnosis, the Edson test can be performed: the patient moves his arm back, and then throws his head back. This increases the compression of the scalene muscle on the subclavian artery. If the test is positive, the arm goes numb and the pain in it increases. The pulse from the radial artery also weakens or disappears completely.

[ 25 ]

Treatment ladder muscle syndrome

There are several methods to treat scalene muscle syndrome. The main treatment methods are presented below.

Physical therapy is very important in the treatment of the syndrome. There are exercises that improve posture and distribute the load on the muscles correctly. They also help increase the range of motion of the shoulder. Strengthening and stretching the muscles of the chest and shoulders can reduce the pressure on the vessels and nerves located between the collarbones and ribs.

Manual therapy that allows mobilization of the ribs and spinal column, increasing the range of motion of the shoulder joint.

In the treatment of the scalene muscle syndrome, blockades are often used, which also help in differential diagnostics. In this case, injections should be performed by a doctor who has experience in such procedures.

Acupuncture, in which needles are inserted into specific biologically active points. This procedure restores the conductivity of impulses along the nerves and reduces pain.

Massage is considered an excellent method of treating the syndrome. This procedure helps to relieve muscle tension and relieve stress. Massage also improves blood circulation in tissues, and muscles get rid of unnecessary metabolic products.

Medicines

Scalene muscle syndrome can be treated with medication.

Nonsteroidal anti-inflammatory drugs - they reduce pain and eliminate the inflammatory process (redness and swelling). Such drugs include ibuprofen, aspirin, celecoxib movalis, naproxin.

Muscle relaxants help with muscle spasms. They relax muscles and reduce pain. Drugs in this group include diazepam, tizanidine, carisoprodol, cyclobenzaprine, and methocarbamol.

Neuropathic drugs that change the nature of neurotransmitter transmission of pain sensations to the brain (head and spinal). Among the medications that help in this way are venlafaxine, desipramine, fluoxetine, citalopram, doxepin, sertraline, amitriptyline, paroxetine, imipramine.

Opiates, which are narcotic analgesics. This medication is only allowed to be used in cases of very severe, unbearable pain, when any other analgesics have proven powerless, having no effect on the damage. In some cases, opiates can be combined with non-steroidal anti-inflammatory drugs - this enhances the analgesic effect.

Vitamins

Vitamin treatment has a positive effect on scalene syndrome, helping to get rid of the symptoms of the disease.

Anti-inflammatory non-steroidal drugs, vasodilators and vitamins from group B are used as medicine. A drug called Neurodiclovit has long been known and popular. It contains diclofenac, which has an anti-inflammatory effect, as well as vitamins of types B1, B6, B12.

Thiamine, or vitamin B1, which, in the process of phosphorylation in the human body, becomes cocarboxylase, which helps improve the process of passing nerve impulses through synapses.

Pyridoxine, or vitamin B6, is a coenzyme of very important enzymes that affect nerve tissue, thereby ensuring proper synaptic transmission. In addition, it stabilizes the relationship between the processes of inhibition and excitation that occur in the central nervous system.

Cyanocobalamin, or vitamin B12, improves the functioning of the nervous system, helps the process of synthesis of the myelin sheath, reduces pain due to disorders in the peripheral nervous system. It is also needed for proper hematopoiesis and normal maturation of red blood cells, good replication and cell growth.

Physiotherapy treatment

To cure the scalene muscle syndrome, physiotherapy procedures are sometimes used. Among them, the following methods are distinguished:

• massage that helps restore the activity of tendons, muscles, receptors and other internal organs. This allows increasing the ability of nerves to regenerate and the permeability of impulses;
• simulated sinusoidal currents that allow for reflexive pain relief and improved tissue nutrition and peripheral circulation. In addition, they stimulate the growth of new blood vessels;
• physiotherapeutic treatment with mud, which has a resorptive, antispasmodic and anti-inflammatory effect;
• ultrasound, which has a resolving, analgesic, antispasmodic, anti-inflammatory effect. It also promotes regeneration and adaptive-trophic activity of systems and organs, improves the body's immunological reactivity;
• electrophoresis, used with the addition of drugs, increases the concentration of drugs in the area of pathology;
• magnetic therapy, which helps to eliminate inflammatory processes and relieve pain. It has a neurovegetative and bactericidal effect.

Folk remedies

During remission, you can use folk remedies during massages.

Calcined cottage cheese helps well with SLM - calcium chloride and milk are needed to prepare it. Heat half a liter of milk to a temperature of 40-60 degrees, then add 1.5 tbsp. 10% calcium. After the milk curdles, remove it from the heat, throw the resulting mass into a sieve, cover with gauze and leave overnight. The finished cottage cheese can be eaten in any quantity.

Scalene muscle syndrome is treated with an ointment based on hop cones - grind them to a powder state, then add 1 tbsp of butter to 1 tbsp of this mixture.

Ointment based on juniper needles and bay leaves - mix 1 tbsp. bay leaves and the same amount of juniper needles, then rub together with 2 tbsp. butter.

In such homemade ointments, butter is used as a base to improve the absorption of the components into the skin. After applying the ointment, you need to rub the sore spot for several minutes, then cover yourself with a blanket or towel and lie down for about 10-15 minutes. Then wash off the ointment.

A medicine made from barberry and rye grains. 250 g of grains are poured with 2 liters of water, boiled, then cooled and filtered. Then 1 kg of honey, 3 tsp of barberry root and 0.5 l of vodka are added to the solution. The mixture should be stirred and put in a dark place for 3 weeks. The medicine is taken before meals in the amount of 3 tbsp.

[ 26 ]

Herbal treatment

Scalene muscle syndrome is treated using various non-traditional methods. For example, herbal treatment is considered a fairly popular method.

Shoulders and neck should be rubbed with cinquefoil tincture several times daily. It would also be useful to take orthilia secunda tincture.

• Barberry with horseradish. You need to chop 1 kg of horseradish and pour 4 liters of water over it, then put this mixture on the fire and cook for 5 minutes. Then you need to let the broth cool down, and then add 500 g of honey to it. The resulting tincture should be kept in the refrigerator. Dosage - 200 g, intake - 1 time / 6 months.
• Wormwood tincture – 1 tbsp. of wormwood is poured with 1.5 cups of boiling water, then infused for 2-3 hours in a thermos. The resulting mixture is filtered and then rubbed into the skin during massage.
• A garlic-based tincture works well – chop 200g of the product and pour half a liter of vodka over it. Leave the tincture in a dark place for 8 days, shaking it occasionally. Then rub it into the skin.
• Infusion of lilac flowers - 1 glass of flowers is infused in 500 ml of vodka for several days, after which the resulting mixture is used for rubbing.
• Ointment from a herbal mixture - mix 1 teaspoon each of mint, celandine, calendula and crushed hop cones, then add 1 tablespoon of butter.

Homeopathy

Scalene muscle syndrome is sometimes treated with homeopathic remedies. They are considered to be quite effective and capable of effectively dealing with diseases of this nature.

Among homeopathic medicines that have an analgesic and antispasmodic effect, as well as eliminating inflammation and stabilizing metabolism, the following preparations stand out: Zincum Metallicum, Argentum Nitricum, Calcarea, Causticum, Ostearum.

In addition, the testing method is used to select the main drugs. This allows you to choose the drug that will be most suitable for the patient. The dosage is selected using the so-called R. Voll device. This method simplifies the process of choosing an individual course of treatment for each patient as much as possible.

You need to take such medications for 3-5 days before starting the treatment course, and then you need to repeat this procedure after the same 3-5 days after the treatment course is completed - to consolidate the effect obtained.

Homeopathy can also be combined with taking distilled water on an empty stomach (this procedure is performed daily). The dosage for 1 day is 150-200 ml. This procedure improves the decalcification process occurring in the body.

Surgical treatment

If you experience discomfort in your hands, your palms begin to swell, and the range of motion of the joints in your hands becomes limited, you should consult a doctor as soon as possible.

Before surgery, they usually try to conduct conservative treatment (2-3 complex therapeutic courses). But if it turns out to be ineffective, they have to resort to surgery. Such procedures as cervical rib resection, scalenectomy or scalenotomy are performed.

Thus, patients whose scalene muscle syndrome has already acquired persistent and very serious symptoms will most likely need surgical treatment. In this case, it will be necessary to "open" the pinched scalene muscle. During the operation, the 1st rib is removed, due to which the damaged blood vessels and nerve are freed from further compression.

The operation is performed in the following order: an incision is made above the collarbone, which provides access to the interscalene space. Further actions depend on the cause of the disease. In some cases, it is necessary to remove the lymph nodes, capturing a little fatty tissue. It may also be necessary to dissect some of the muscle to relieve pressure on the vessels and nerves in the gap.

Exercises for scalene syndrome

The scalene muscles are located deep within the layers of tissue of the neck muscles, descending from the lower region to the 1st and 2nd ribs. When inhaling, the muscles raise the ribs. Their tension occurs when the 1st rib is blocked, which occurs where it is attached to the sternum, or where it is attached to the processes of the 1st sternum vertebra. The vertebral joints located at the transition of the cervical vertebrae to the thoracic vertebrae can also be blocked. This is the pathogenesis of the scalene muscle syndrome.

To relieve the discomfort that accompanies this disease, you need to do some exercises.

To stretch the muscles, it is suggested to sit on a chair, leaning your back against its back, and place the palm of the hand that is on the sore side on the upper ribs located under the collarbone.

Turn your head to the healthy side and place your hand on the same side on your forehead in a position where your fingertips touch the upper side of your eye socket. Grasp your head and tilt it to the healthy side a little back and to the side. You need to tilt it until you feel a pre-tension. Inhale and look up. The hand on your ribs will prevent you from lifting their upper part. Exhale and lower your eyes, and with the hand on your head, tilt your head slightly to the side and back again.

This set of exercises for scalene muscle syndrome will help relieve pressure on the neurovascular complex and reduce pain.

[ 27 ]

Prevention

If you have pain in your neck, it may be scalene syndrome. This condition develops as a result of severe overstrain of the anterior scalene muscle, which begins to compress the nearby nerve fibers.

When preventing this syndrome, emphasis should be placed on therapeutic exercise. There is a whole range of different physical exercises that are performed on exercise machines specially designed for rehabilitation.

Sessions of therapeutic and health-improving physical training allow you to contract and relax the neck muscles, skillfully alternating this process. This allows you to create not only a positive effect on the course of existing symptoms of the syndrome, but also prevent the development of other pathological processes that are the cause of this syndrome.

Thanks to rehabilitation exercise machines it is possible to:

• Target the affected areas;
• Relieve tension in the neck muscles.

In addition, therapeutic exercises on exercise machines, unlike the use of painkillers (they only relieve pain for a while), eliminate the very cause of the development of the syndrome, thereby ensuring the complete recovery of the patient.

[ 28 ]

Forecast

The scalene muscle syndrome, like other cervical-brachial diseases, is revealed in the form of neurological symptoms that have different causes and pathogenesis. It manifests itself in the form of paresis, vasomotor, muscle-tonic, and neurodystrophic disorders, muscle pain that can spread to the shoulders, arms, and neck.

In general, the prognosis for this disease is optimistic, but relapses may occur.

[ 29 ], [ 30 ], [ 31 ]