The Efficacy of Scalene Injection in Thoracic Outlet Syndrome

OBJECTIVE: To evaluate the efficacy of scalene injection in patients with thoracic outlet syndrome. METHODS: We selected 142 patients diagnosed with thoracic outlet syndrome between January 2005 and October 2009. We performed a series of scalene injection with conservative treatment in all cases. Patients rated their pain degrees using a visual analogue scale. We also evaluated the time to return to everyday life and work, and patients' functional capacity. RESULTS: There were no complications or instances of inadvertent somatic or sympathetic ganglionic blockade after scalene injection. Overall, 111 patients (76.5%) experienced improved symptoms after the first set of scalene injection and 128 patients (88.2%) improved after scalene injection followed by conservative treatment. Of the 68 patients who returned to work during the study period, 54 returned within 1 week, and 62 within 2 weeks. Of those who returned to work, 61 reported nearly full functional capacity. We found that scalene injection was more effective in cases of thoracic outlet syndrome related to trauma than in those related to work-related repetitive stress. CONCLUSION: In patients with thoracic outlet syndrome, scalene injection effectively reduces pain. We recommend scalene injection as an adjunct to conservative treatment.

Thoracic Outlet Syndrome Caused by Automobile Accident

PURPOSE: Thoracic outlet syndrome (TOS) causes pain, paresthesia and muscle weakness in neck, upper back, and the upper limbs. The etiologic factor of TOS is associated with car accident. However, in many cases diagnosis of TOS is underdiagnosed and proper treatment was not performed, which consequently lead to chronic pain status. The authors report of cases diagnosed with TOS following car accidents in our hospital. MATERIALS AND METHODS: The retrograde study was conducted on 12 subjects who reported of neck pain and numbness following car accidents from January 2006 to June 2009. The study was conducted through telephone interviews and surveys to investigate the mechanism of the accidents, clinical manifestation, duration of the symptoms from diagnosis to treatment, treatment course and prognosis. RESULTS: Of the 12 subjects diagnosed with TOS, 9 of them were caused by whiplash injuries, and 3 of them were due to lateral side injuries. l0 of the subjects complained of cervical pain and upper limb paresthesia, 4 of the subjects had upper limb pain and 3 of them had only cervical pain as chief complaint. All of the subjects were underwent anterior scalene injections. A total of 8 subjects who were diagnosed with TOS within 4 weeks of the causal event showed symptom improvements while in the group of subjects who were diagnosed after 4 weeks after the injury, only 2 of the subjects showed recovery, 2 recovered for only a brief period of time after the scalene injection and showed chronic pain status. In the 2 cases initially diagnosed as cervical whiplash injury, the diagnosis of TOS was done in 3months and 6months after the accident respectively and the treaatment was delayed. CONCLUSIONS: There is high possibility of TOS after car accidents if cervical pain and numbness on the upper extremity are observed. Better clinical course and prognosis is expected in subjects who were diagnosed and treated within 4 weeks.