Anterior scalene injections in the treatment of the disputed type thoracic outlet compression syndrome
Cengiz Yılmaz1, İ Kaan Kayahan2, Sinan Avcı3, Metin M Eskandari1, Abtullah Milcan1
1Department of Orthopedics and Traumatology, Medicine Faculty of Mersin University
2Departments of Neurology, Ankara Güven Hospital
3Departments of Orthopedics and Traumatology, Ankara Güven Hospital
Keywords: Exercise therapy; injections, intramuscular; methylprednisolone; neck muscles/pathology; posture; thoracic outlet syndrome/therapy; treatment outcome.
Objectives: We evaluated the efficacy of anterior scalene injections added to treatment with exercise and medications in patients with the disputed type thoracic outlet compression syndrome (TOCS).
Patients and methods: The study included 60 patients (55 females, 5 males; mean age 34 years; range 20 to 54 years) who were clinically diagnosed as disputed type TOCS. The main complaint was generalized pain in the upper extremity and neck in 42 cases (70%) and shoulder pain in 18 cases (30%). The average duration of symptoms was 11 months (range 15 days to 6 years). The patients were randomly divided into two groups. One group (30 patients, 38 extremities) was prescribed a home exercise program with proper medications, while the other (30 patients, 40 extremities) additionally received corticosteroid injections into the anterior scalene muscle. The results were evaluated with the use of a visual analog scale (VAS) before treatment and after the first, third, and sixth weeks, and then, the third and sixth months of treatment.
Results: The mean VAS scores of the two groups were similar before the treatment. Compared to the exercise group, significantly lower mean VAS scores were observed in the injection group in the first, third, and sixth weeks (p<0.001). However, the difference was not significant in the third and sixth months (p>0.05). The mean VAS scores obtained before the treatment and at the end of the follow-up showed a significant improvement in both groups (p=0.001).
Conclusion: We recommend anterior scalene injections during acute exacerbations of the disease for pain control and relief in patients with the disputed type TOCS.