Dr. Michie

Peripheral Entrapment Neuropathy #3

Scalenus Anticus Syndrome

This peripheral entrapment neuropathy, Scalenus Anticus Syndrome, is one of the more difficult to manage due to its location.  Otherwise known as one of the culprits in Thoracic Outlet Syndrome, this neuropathy is due to the neurovascular bundle (nerves, blood vessels) coursing through the anterior and middle scalene muscles (muscles along the front/side of the neck).

Anatomy
The Scalenes are strap like muscles that attach along the side of the neck and attach to the first rib on each side of the body.  The brachial plexus and the subclavian artery pass between the two scalene muscles.  The Scalene muscles are very susceptible to postural stress, head/neck trauma and tension/spasms.

Signs and Symptoms

The Scalenes, when causing compression on the brachial plexus nerves or the subclavian artery will cause pain characterized by sharp, burning or aching involving part of the hand (4th and 5th fingers), all of the hand, or the inner aspect of the forearm and upper arm.  Pain can also invlove the side of the neck, the pectoral area below the clavicle, the armpit/axillary area and the upper back (trapezius & rhomboid area).  Decoloration of the hands, one hand colder than the other hand, weakness of the hand and arm muscles and tingling are common presenting symptoms.  A painful, swollen and cyanotic (blue) arm, particularly following strenuous physical activity, could be a telltale sign of subclavian vein compression.

Diagnosis 

Physical exam will reveal muscular, vascular and/or nerve involvement with specific testing.  For instance, Adson’s, Costoclavicular and even the Compression Test maneuvers can uncover the compromised effect to the extremity (numbness, pain and/or radiation).  These tests are performed by a trained clinician (doctor of chiropractic, orthopedist, etc.)  Doppler Arteriography, Doppler Ultrasound and even cervical + soft tissue/brachial plexus MRI are valuable diagnostic tools frequently incorporated in the diagnostic work-up to assess cause and point of origin pathology.  This will also reveal if there is a “cervical rib”  or first rib restriction – a not too uncommon finding in this clinical situation.  Applied Kinesiology (AK) is an excellent method of clinical evaluation of root cause of peripheral neuropathy from the scalenes.  This technique utilizes muscle testing to isolate the joint, muscular and/or biomechanical origin of this condition.  Postural evaluation will typically reveal the forward head posture, shortened chest (pectorals) muscles and even winging scapulae (protruded shoulder blades).  These structural faults are all contributory to the scalene compression of nerve/vascular tissues and should be addressed with manual therapy and specific exercises – this component should be managed aggressively to avoid unnecessary intervention and frustration.

Management   

  1. 1.     Stretching – neck, shoulder and back stretches should be implemented 2-3X/day (desk stretches) to “break the chains” of the shortened muscles!
  2. 2.     Chiropractic adjustments – clearing out the cervical, thoracic spine and upper extremity will release all joint restrictive binding regions in this kinetic chain issue
  3. 3.     Manual therapy – myofascial release, neuromuscular massage therapy and myofascial stretch therapy will all provide a clearing effect for this difficult region of compression
  4. 4.     Myofascial Dry Needle Therapy – this progressive treatment will release any recalcitrant trigger point/soft tissue adhesion to release the nerve/vascular restriction via precisely placed acupuncture needles
  5. 5.     Electrical Trigger Point Therapy – this modality not only isolates the offending muscle(s) but it releases them along the entire soft tissue track of restriction
  6. 6.     Nerve Gliding  – specific exercises addressing the neck, shoulder and arm-hand-fingers to release the irritated/compressed nerve can be taught and implemented to assist in the healing process
  7. 7.     Cervical Pillow – www.therapeutica.com – excellent therapeutic pillow for proper alignment when sleeping
  8. 8.     Clinical Nutrition – Clinical dosing of Proteolytic Enzymes (Protrypsin – Metagenics), Omega Three Fatty Acids (Omega Pure 600 – Xyomgen), Vitamin B6 + Magnesium (E-Z Flex – Metagenics), Vascular support (Niatain – Metagenics),  Natural anti-inflammatory support (Inflavonoid – Metagenics) will all collectively support the healing process by addressing inflammation, pain, nerve, vascular and muscular involvement.  Consult a clinician on proper dosing for efficacy!
  9. 9.     Avoidance of gluten, dairy and sugar will always facilitate healing
  10. 10.  Avoidance of poor desk posturing, not taking timely stretch breaks and exercising without over stressing the shoulder girdle, neck muscles and shortening the pectorals will all facilitate healing and stabilizing this condition
  11. 11.  For recalcitrant cases – trigger point injections Botox and even surgical release are considered. 

So as you can see from this brief article, many neurological conditions/symptoms require a thorough work-up and care plan and typically have conservative solutions!  However, the longer one waits to deal with the issue, the more complex it becomes.  Listen to the body and address the cause!!

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Dr. John Michie

About Dr. John Michie

John L. Michie, D.C., C.C.S.P., founder of Whole Health Chiropractic, embraces Edison's wisdom and incorporates a balance of nutrition, exercise, physiotherapy and chiropractic care to positively impact his patients’ health. Whole Health Chiropractic is a holistic, patient-centered practice. "It's our goal to uncover the causes of debilitating symptoms and follow with an action plan that addresses necessary steps for sustained healing."

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