Scalene Anatomy.

Scalenes are a group of three muscles originating from the sides of the neck vertebra running down and forward attaching to the first and second ribs.  Front and middle scalene attach to the first rib and the back scalene attaches to the second rib.  The function of these muscles is to help elevate the rib cage during a deep inhalation. The front and the middle scalene along with the first rib create a triangle of space between them. This space allows all the nerves that travel down the arm to pass through. If these scalene muscles are tight they cause compression passing though the triangular space.  Usually this nerve compression will affect only one major nerve such as in Anterior Scalene Syndrome. In severe cases it can affect multiple nerves causing many symptoms in the arm down to the hand such as in Costoclavicular Syndrome combined with Anterior Scalene Syndrome..

 

What are the symptoms of Scalene Syndrome

Because this compression can affect any nerve of the upper extremity it can create many symptoms.  The symptoms can resemble nerve impingements from a herniated disc in the neck to carpal tunnel.  Scalene Myofascial Pain Syndrome can also affect muscles in the upper extremity mimicking many common muscular conditions such as rotator cuff injuries and tennis elbow.  Diagnoss is every difficult because it mimics many other conditions affecting the upper extremity and we really do not have reliable orthopedic tests to confirm a diagnosis.

Common symptoms include:

  • Numbness in the arm and hand affecting any and possibly all the fingers
  • Pain radiating down the arm
  • Pain in the shoulder and middle back
  • Pain on the side of the neck
  • Neck stiffness
  • Weakness in the arm and hand

How is Scalene Syndrome treated?

We successfully treat Scalene Syndrome with Chiropractic Care and Massage Therapy in our office.  A goal of the treatments is to relax the scalene muscles and correct the postural imbalance that led to the tightness. The cause of Scalene Syndrome is related to having an Anterior Head Carriage posture.  For correction we teach home care stretching and workplace modifications to correct the cause on anterior head carriage.  I also see cases related to motor vehicle whiplash type injuries and on rare occurrences we will find chronic respiratory issues as the cause.  Scalene muscles work hard when someone is having difficulty breathing such as in chronic asthma or COPD.  In cases related to respiratory overwork we have the patient consult a primary care physician to assess and manage the condition as we continue with Chiropractic Care and Massage Therapy.