Surgery Best for Exercise-Induced Scalenus Syndrome

Scalenectomy, when performed as a treatment for exercise-induced scalenus syndrome, can allow professional athletes to return to full activity relatively quickly, according to a new study.

Researchers at the University of Athens (Greece) reported on 12 professional athletes (mean age 27.9 years) who were examined between 1993 and 2004 for various upper extremity symptoms that indicated possible thoracic outlet syndrome (TOS). Eight cases were entirely neurologic in nature, while four were a combination of vascular and neurologic thoracic outlet syndrome. Four patients had bilateral involvement. Diagnosis of scalenus anticus syndrome was based on patient histories, clinical findings (including the Adson test, which was positive in all cases), and imaging. In all 12 cases included in this series, symptoms were severe and not amenable to nonoperative management. Moderate to severe hypertrophy of the anterior scalene muscle was confirmed in all cases. The surgical technique involved approximately one-centimeter reduction in width of the anterior scalene muscle via a supraclavicular approach.

The researchers reported that post-operative treatment included physical therapy, and follow-up examinations were conducted at 3, 6, and 12 months, with total follow-up going to 3 years. In the early postoperative period, nine of the patients rated the surgical result as excellent, and the remaining three, who were the oldest patients and had had symptoms the longest, rated it as good. All patients eventually resumed their usual daily routine and athletic activities, and no relapses were reported. The study was published in the February 2008 issue of the American Journal of Sports Medicine.

"Rowing, wrestling, judo and javelin are among the sports that can lead to anterior scalene muscle hypertrophy,” said co-author George Prionas, M.Sc. "The anatomic area we are talking about is quite compact, and the space for the muscles to increase their size without causing any problem is limited.”

Thoracic outlet syndrome consists of a group of distinct disorders that affect the nerves in the brachial plexus and the subclavian blood vessels between the base of the neck and the axilla. For the most part, these disorders are produced by compression of these components. The compression may be positional, i.e., caused by movement of the clavicle and shoulder girdle on arm movement, or static, i.e., caused by abnormalities or enlargement of the various muscles (such as the Scalenus Anticus) surrounding the arteries, veins, and brachial plexus.


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