Stair Muscle Syndrome

The stair muscle syndrome is a combination of symptoms that include a feeling of thickening or thickening in the front staircase, as well as its spasm. In addition, there is a 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 indicated above.

[1], [2]

Causes of the staircase syndrome

Often problems with the front staircase begin because of the development of osteochondrosis of the thoracic spine and neck. Sometimes the syndrome can form due to abnormal location of the neck ribs or some kind of injury. The disorder often develops in adolescents who are actively involved in sports, because the muscles are constantly traumatized - the skeleton grows at an accelerated pace and receives large physical loads.

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

[3], [4]

Pathogenesis

The stair muscle syndrome is characterized by pains that begin in the area of the shoulder and neck area, descending down the ulnar part of the arm. Such feelings cause patients to complain that they are not able to work, raising their hands up and generally lifting any heavy objects. The pain intensifies if you start moving your neck, arms and body, and also when you turn your head. At the same time, the head may get sick, and paresthesia may appear in the hand. The head can ache due to the occurrence of vertebral-basilar insufficiency and compression of the artery of the spine. In addition, the cause may be the transfer of pain impulses from the shoulder to the neck.

There is an opinion that, most likely, the humerous pathology, which appeared due to myofascial and muscular-tonic syndromes of the shoulder girdle and motor impairment in the cervical part of the spine, is combined here.

Other factors that have a different pathogenesis, the appearance of pain in the shoulder and neck, as well as problems with their motor functions, should also be considered. Among such causes are various disorders in the brachial plexus and separate bundles of nerves and vessels, which often happens in the course of the progress of destructive and degenerative processes or tunnel syndromes. They appear on the background of vascular diseases, leading to local hemodynamic disorders, and neoplastic processes.

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

Symptoms of the staircase syndrome

The syndrome of the stair muscle manifests itself as a pain that spreads from the shoulder to 4-5 fingers, and in addition, as the disappearance of the sensitivity of the limb. Sometimes the pain can spread to the back of the head, especially when you turn your head, and move into the sternum, as with angina.

With the development of the disease, the blood flow of the pulse decreases, as well as the lowering of arterial pressure in the limb. There is cyanosis, the hand itself begins to grow drowsy under the place of squeezing. When viewed with palpation in the anterior muscle, tension is felt.

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

Symptom of stairway muscle syndrome may be a reflex painful spasm, which appeared as a result of the cervical osteochondrosis-induced effect on the roots. The anterior muscle is located between the fibers of 3-6 vertebrae (located transversely) and the first upper rib. Because of the contracture of the muscle, the artery located under the clavicle and the lower part of the plexus (shoulder), located between it and the rib, are strongly squeezed.

It is very important to distinguish in time the manifestations in the syndrome of the anterior staircase muscle from a similar Pancostic syndrome - malignant neoplasm of the apex of the lung.

First signs

The syndrome of the staircase muscle is revealed under the guise of strong pain sensations in the neck, which are especially pronounced when the head is turned to a healthy side. If the head is not slightly inclined forward on the sore side, the pain from the neck along the inner shoulder side, as well as the forearm, will reach the brush itself and further to the fingers. Also in this area, because of the disorder, atrophy and weakening of interstitial muscles, long finger flexors and muscles of the toe-and-toe elevation may develop.

When squeezing the artery under the clavicle, as well as the periarterial bundle, the first signs usually weaken the pulse located on the radial artery. In addition, the brush swells, ischemic crises begin to manifest with an intermittent reaction, in which the fingers turn pale and aching than resemble the so-called Raynaud's disease.

It should be borne in mind that, with optimal physiological and physical indices, the arm bent at the elbow at 45-180 ° will lead to a weakening or complete disappearance of pulsation in the radial artery. Since the anterior muscle lifts the first rib on the inspiration as an auxiliary, the deep drawing in of the 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 for a long time will be the fixation of the muscles, which occurs completely reflexively. They have to withstand the pose until the moment when the pain decreases. But such a reflex protective reaction will only strengthen the painful sensations and contribute to the development of the disease.

Because of the defensation of the muscles, it is necessary to later conduct another one, separate from the main, course of treatment. It is very important not to miss the onset of the development of the syndrome, discovering and starting the treatment even at the very initial stage. In the absence of proper attention and treatment, stair muscle syndrome can cause traumatization of tissues in the vessels, as well as nerve fibers, which in the future may even have to amputate the hand.

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

Diagnostics of the staircase syndrome

Diagnosis of stair muscle syndrome is a rather difficult task. Signs in their expressiveness and character very much depend on individual characteristics of a person. In addition, many of the symptoms are similar to those that occur in other diseases. For example, it can be such diseases as violations in the cervical vertebral column, because of which the roots are compressed, and also the trauma of the rotator cuff. Thanks to a physical examination and a medical history, you can find out when the disease started, 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 in the shoulder appears a restriction in the amount of movement. At a physical examination, the doctor performs procedures to identify other symptoms - it determines the level of pressure of the pulse on the hands (healthy and sick) with their different locations.

The doctor diagnoses the staircase muscle syndrome on the basis of the symptoms manifested during the examination. With certain movements of the neck and arm, painful pain and loss of pulse may appear. When diagnosing the syndrome, the following procedures are performed: an electromyogram, as well as an angiogram. They allow us to examine the compressed part of the blood vessels.

[18], [19], [20]

Analyzes

The staircase muscle syndrome can be diagnosed on the basis of laboratory test data. To do this, patients take various blood tests - common, for sugar and hormones, as well as urinalysis.

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

Instrumental diagnostics

Such methods are used for instrumental diagnosis of this disease.

• Electromyography, which allows you to learn how muscles and nerves work - small needle electrodes are injected into the damaged muscle, and they measure what electrical activity it is at the time when it is innervated by a nerve. The pathological muscle reaction demonstrates the state of the nerve that is connected to this muscle.

In addition, the EMG makes it possible to know the rate of passage of the pulse through the nerve end. The procedure is carried out by the method of placing electrodes on the skin. At the speed of the pulse through each nerve end there is a specific average, so any deviation from it will mean there is a violation in it.

Thanks to an X-ray, it is possible to detect changes in the bones of the ribs and chest.

• To examine the circulation in the hand, use ultrasound (this procedure is also called scanning vessels of Doppler).
• With the help of MRI, you can find out the reason for the squeezing of the vessel or nerve.
• Computer tomography makes it possible to trace changes that occur in bone tissues.
• Ultrasound imaging vessels (arteries and veins) to detect the presence of blood clots.
• Angiography, in which veins and arteries are checked for blood clots and other disorders in the circulatory system.

All this helps to diagnose staircase muscle syndrome.

Differential diagnosis

Syndrome of staircase is referred to the group of tunnel syndromes. The main cause of its appearance is osteochondrosis of the spine, in which irritation of 3-7 cervical roots is observed. The causes are also muscle overstrain, the presence of the cervical rib, instability of the cervical vertebrae, which causes myofasciopathy of the stair muscles (middle and front).

To help differentiate this syndrome with other diseases, use a clinical examination, as well as other procedures, including methods such as thermovision, electroneuromyography, x-rays and, in some cases, computed tomography.

Differential diagnosis is carried out with the help of clinical examination: palpation on the neck reveals a one-sided edema, a thickening of the left or right muscle, as well as painful sensations in them.

To clarify the diagnosis, Edson's test can be performed: the patient withdraws his hand, and then throws back his head. This increases the compression of the stair muscle to the subclavian artery. If the sample is positive, the hand grows dumb, and the pain becomes worse. The pulse also weakens or disappears completely from the radial artery.

[25]

Treatment of the staircase syndrome

You can treat stair-muscle syndrome in several ways. Below are the main methods of treatment.

Therapeutic physical training during the treatment of the syndrome is very important. There are exercises that improve posture and correctly distribute the load on the muscles. They also help to increase the motor volume of the shoulder. Strengthening and stretching the muscles of the chest and shoulders, you can reduce the pressure on the vessels and nerves, located between the clavicles and ribs.

Manual therapy, which allows you to mobilize the ribs and vertebral column, increasing the motor volume of the shoulder joint.

In the treatment of stethalgia syndrome, blockades are often used, which also help in differential diagnosis. Injections in this case should be carried out by a doctor who has experience of conducting similar procedures.

Acupuncture, in which needles are injected into certain, biologically active points. This procedure restores the patency of the nerves and reduces pain.

A great method of treating the syndrome is massage. This procedure allows you to relax the tension in the muscles, as well as relieve stress. Also, thanks to massage, blood circulation in tissues improves, and muscles get rid of unnecessary metabolic products.

Medications

The stair muscle syndrome can be treated with medication.

Nonsteroid drugs that prevent inflammation - they reduce pain and remove the inflammatory process (redness and swelling). Such drugs are ibuprofen, aspirin, celecoxib movalis, naproxin.

Muscle relaxants help in the occurrence of muscle spasms. They relax the muscles and reduce pain. The drugs of this group include diazepam, tizanidine, carisoprodol, cyclobenzaprine, methocarbamol.

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

Opiates, which are narcotic analgesics. This medicine is allowed to use only in case of very strong, intolerable pain, when any other analgesics were powerless, without having any effect on the damage. In some cases, it is possible to combine opiates with anti-inflammatory non-steroid drugs - this enhances the analgesic effect.

Vitamins

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

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

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

Pyridoxine, or vitamin B6, is a coenzyme of very important enzymes that act on neural tissues, thus providing the correct synaptic transmission. In addition, it stabilizes the relationship between the deceleration and excitation processes manifested in the central HC.

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 ripening of red blood cells, good replication and cell growth.

Physiotherapeutic treatment

To cure the syndrome of the staircase, physiotherapeutic procedures are sometimes used. Among them, the following methods are distinguished:

• massage, helping to restore the activity of tendons, muscles, receptors and other internal organs. This allows you to increase the ability of the nerves to regenerate and patency of impulses;
• simulated sinusoidal currents, allowing reflexively remove pain, and improve tissue nutrition and peripheral circulation. In addition, they are a stimulant for the growth of new vessels;
• physiotherapeutic mud treatment, which has a resolving, antispasmodic and anti-inflammatory effect;
• ultrasound, which performs a resolving, analgesic, antispasmodic, anti-inflammatory effect. It also promotes regeneration and adaptation-trophic activity of systems and organs, improves the immunological reactivity of the organism;
• electrophoresis, used with the addition of drugs, increases the concentration of medications in the focus of pathology;
• magnetotherapy, which allows to remove inflammatory processes and relieve pain. It has a neurovegetative and bactericidal effect.

Alternative treatment

During remission with massages, you can use alternative treatment.

When SLM is well assisted by calcined cottage cheese - for its preparation you need calcium chloride, and also milk. Warm up half a liter of milk to a temperature of 40-60 degrees, after which we add 1.5 tbsp. 10% of calcium. After the milk is curdled, you need to remove it from the fire, recline the resulting mass on a sieve, cover with gauze and leave for the night. Ready cottage cheese can be eaten in any quantities.

The stair muscle syndrome treats ointment on the basis of cones of hops - grind them to the state of powder, then to 1 tablespoon. Add 1 tablespoon to this mixture. Butter.

Ointment based on juniper needles and laurel leaves - mix 1 tablespoon. Laurel leaves and as many juniper needles, after which we rub together with 2 tablespoons. Butter.

In such homemade ointments, butter is used as a base to improve the absorption of components into the skin. Applying ointment, you need to rub the sore spot for a few minutes, then take cover with a blanket or towel and lie down for about 10-15 minutes. Then the ointment needs to be washed off.

A medicine from barberry and rye grains. 250 g of grains are poured into 2 liters of water, boiled, and then cooled and filtered. Further in the solution add 1 kg of honey, 3 tsp. Barberry root and 0.5 liters of vodka. The mixture must be stirred and placed in a dark place for 3 weeks. The medication is taken before meals in the amount of 3 tbsp.

[26]

Herbal Treatment

Syndrome of stair muscle is treated with various non-traditional methods. For example, a rather popular method is treatment with herbs.

The shoulders and neck should be rubbed with a tincture of saber every day. It will also be superfluous to take tincture from the borry.

• Barbaris with horseradish. It is necessary to cut 1 kg of horseradish and pour 4 liters of water, then put this mixture on the fire and cook for 5 minutes. Next, you need to let the broth cool, and then add 500 g of honey to it. The resulting tincture should be kept in the refrigerator. Dosage - 200 g, reception - 1 time / 6 months.
• Tincture of wormwood - 1 tbsp. Wormwood pour 1.5 cups of boiling water, then insist for 2-3 hours in a thermos. The resulting mixture is filtered and then rubbed into the skin with a massage.
• Well treats tincture based on garlic - crush 200g of the product and fill the floor with a liter of vodka. Within 8 days, tincture should be insisted in a dark place, at times shaking. After that, rub into the skin.
• Infusion of lilac flowers - 1 glass of flowers is infused for several days in 500ml of vodka, after which the resulting mixture is used for rubbing.
• Ointment from a grassy mix - we mix on 1 ch.l. Mint, celandine, marigold and sprouted cones of hops, after which add 1 tablespoon. Butter.

Homeopathy

The staircase muscle syndrome is sometimes treated with homeopathic remedies. They are considered quite effective and able to cope with diseases of this nature.

Among the homeopathic medicines that exert an analgesic antispasmodic effect, and also eliminate inflammations and stabilize the metabolism, there are such preparations as Cincum Metallicum, Argentum Nitricum, Calcarea, Causticum, Ostrearum.

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

You need to take such medications within 3-5 days before the beginning of the treatment course, and later you need to repeat this procedure after the same 3-5 days after the course of treatment is completed - in order to consolidate the effect.

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

Operative treatment

If in the hands you have unpleasant sensations, the palms begin to swell, and the amplitude of the movements of the joints in the hands became limited, it should be consulted as soon as possible with the doctor.

Before surgical intervention, usually try to conduct conservative treatment (2-3 complex therapeutic courses). But if it turns out to be ineffective, you have to resort to prompt intervention. There are such procedures as cervical rib resection, scalenectomy or a scalenotomy.

Thus, patients who have stair muscle syndrome have already acquired persistent and very serious symptoms will most likely need to undergo surgical treatment. In this case, it will be necessary to "open" the clamped ladder muscle. During the operation, the 1st rib is removed, so that the damaged blood vessels and nerve are released from the subsequent compression.

The operation proceeds in this order: an incision is made over the clavicle, which provides access to the interstitial space. Further actions depend on the cause of the disease. In some cases, you have to remove the lymph nodes, while capturing a little fat. It may also be necessary to dissect some part of the muscle to remove pressure on the vessels and nerves in the slit.

Exercises with stair muscle syndrome

Stair muscles are located deep inside the layers of the tissues of the neck muscles, descending from the lower region to the 1st and 2nd ribs. When inhaled, the muscles raise the ribs. Their tension occurs when the blocking of the first rib occurs, which occurs where it is attached to the sternum, or where it is attached to the processes of the first vertebra of the sternum. Vertebral joints located at the site of the transition of the cervical vertebrae to the thoracic vertebrae can also be blocked. It is this pathogenesis has the syndrome of the staircase muscle.

To calm down the unpleasant sensations accompanying this disease, you need to perform some exercises.

To stretch the muscles, it is suggested to sit on a chair, resting on his back with his back, and place the palm of his hand, which is located on the diseased side, on the upper ribs under the collarbone.

The head is turned into a healthy side, and the hand from the same side is put on the forehead in the position where the tips of the fingers touch the upper side of the orbit. We grab our head and bend it into the healthy side a little back and to the side. Tilting is necessary until the moment of appearance of the prestress state. Inhale, look up. The hand on the ribs will interfere with the lifting of their upper part. Exhaling, we lower our eyes, and again with the hand that lies on the head, we incline our heads slightly to the side and back.

Such a complex of exercises in the syndrome of the staircase muscle will ease the pressure on the neuro-vascular complex and weaken the pain manifestations.

[27]

Prevention

If you have a pain in the neck, it is possible that this is a syndrome of the staircase. This condition develops due to a strong overstrain of the front staircase, which begins to squeeze the nearby nerve fibers.

Carrying out the prevention of this syndrome, you should focus on therapeutic physical training. There is a whole range of different physical exercises that are performed on specially designed simulators for rehabilitation.

Sessions of therapeutic and recreational physical education allow you to reduce and relax the muscles of the neck, intelligently alternating this process. This allows you to create not just a positive effect on the course of already existing symptoms of the syndrome, but also to prevent the development of other pathological processes that are the cause of this syndrome.

Thanks to rehabilitation simulators it is possible:

• Point to influence affected areas;
• Remove the overstrain in the muscles of the neck.

In addition, therapeutic exercises on the simulators, in contrast to the use of pain medication (they only take pain for a while), eliminate the very cause of the syndrome, thus ensuring a complete recovery of the patient.

[28],

Forecast

Syndrome of the staircase, like other cervico-brachial diseases, is revealed in the form of neurologic symptoms, having different causes and pathogenesis. It manifests itself in the form of paresis, vasomotor, muscular-tonic, as well as neurodynamic disorders, muscle pain, which can spread to the shoulders, arms and neck.

In general, with such a disease, an optimistic prognosis is given, but relapses may occur.

[29], [30], [31],