SCALENE SYNDROME (synonym: Naffziger's syndrome, syndrome of a costoclavicular compression, syndrome of a cervical edge, scalenus-anticus syndrome) — the pain syndrome caused by narrowing of a crack between front and average ladder muscles and a prelum of the neurovascular bunch of an upper extremity passing through it. Develops gradually, more often at the age of 30 — 40 years. Emergence of a syndrome contacts bone anomalies, patol, changes in scalenes, and also neuroreflex influence on muscles at osteochondrosis and diseases of internals. Defeat of a front scalene can be caused by a muscle tension of a shoulder girdle at certain types of work. Tension and a hypertrophy of a front scalene, and sometimes fibrous regeneration causes it reduction of interladder and costoclavicular spaces. It leads to irritation of roots of a brachial plexus (C8 — D1) and to emergence of crimpiness of a subclavial artery and vein. As a result the pain syndrome, vascular and neurovegetative disorders develops. At survey attract attention a swelling in supraclavicular area on the party of L. m of page, strengthening of the vascular drawing of veins on a breast and in a shoulder. Are characteristic a short neck, existence of rudimentary cervical edges, a curvature of cervical department of a backbone is possible.
L. the m of page is more often shown by a complex of symptoms of defeat of nervous, arterial and venous systems and very seldom one of them. The most constant symptom are hand pains, is preferential in an ulnarny zone of a forearm and a brush. They can be spontaneous, but arise during the work more often. Pains happen acute, shooting, sometimes burning to a big zone of distribution, amplify usually during sleep. Often they are combined with acroparesthesias in ulnarny, is more rare in a radial zone of a brush and a forearm. Motive frustration are characterized by increased fatigue or decrease in an animal force in distal departments of a hand, especially in the IV—V fingers, is more rare in proximal departments. In muscles of an ulnarny zone of a forearm and a brush, especially eminences of a little finger, hypotonia and a hypotrophy is noted. Vegetovascular disturbances in the form of Reynaud's syndrome — feeling of a cold snap, blanching, a posineniye come to light, sometimes erubescences it is preferential in distal departments of a hand. Bernard's syndrome — Horner is sometimes noted (see. Bernard-Horner syndrome ). Many patients complain of pains in heart, to-rye arise or amplify at a deep breath or an exhalation, turns of a trunk or at the movement by the left hand. There can be a circulatory unefficiency in vertebrata and basilar arteries usually in the form of repeated kokhleovestibulyarny crises. Headaches, generally occipital localization are quite often noted. The pulsation of subclavial and beam arteries is weakened or is absent. Auskultativno comes to light systolic noise in supraclavicular area. Decrease in the ABP on the affected extremity, sometimes to zero is characteristic.
Recognition of a syndrome of a front scalene is helped by Lange's test — disappearance of a pulsation on a beam artery at assignment and raising of a hand with simultaneous turn of the head to the opposite side up. At a palpation the hypertrophied tight front scalene, and also morbidity over - and subclavial points is found. Important diagnostic value has temporary regress of symptoms after infiltration of a front scalene solution of novocaine. A compression of vessels at L. the m of page can cause fibrinferments of the most subclavial artery or its distal branches, formation of post-and pristenotichesky aneurisms with a possibility of an embolism, disturbance of blood circulation in a subclavial vein (see. Pedzheta — Schröter a syndrome ). The condition of blood circulation in system of a subclavial artery is studied by means of termografiya (see), aortografiya (see), a volume sfigmografiya or a vazoreografiya (see. Reografiya ) with simultaneous test of Lange, and in system of a subclavial vein — with the help flebografiya (see).
There are conservative and operational methods of treatment. In an initial stage of a disease the novocainic infiltration in the place of an attachment of a front scalene removing its spasm is most effective. Apply also the analgetics, sympatholytics, drugs improving a peripheral blood stream and reducing a muscle tension, physiotherapeutic procedures (diadynamic currents or an ionophoresis novocaine, Trimecainum on area of a neck and nadplechiya, massage of a collar zone of the affected extremity). As the indication to operational treatment can serve expressiveness vascular and nevrol, disturbances, especially pains, and vegetovascular frustration, resistance to conservative treatment and a progrediyentnost of a current, existence of bone anomalies and complications, and also data elektrofiziol, and rentgenologich. researches. Operational treatment is directed to recovery and improvement of a blood-groove on arterial and venous vessels, and also to elimination of a factor of a mechanical prelum of a brachial plexus and vegetative fibers in boundaries a ladder interval. Apply a scalenotomy or a scalenectomy, it is frequent in combination with a periarterial sympathectomy, a partial or full resection of cervical edges or hypertrophied cross shoots of the VII cervical vertebra, according to indications — crossing of fibers of an average scalene, reconstructive a subclavial artery and vein operations in cases of disturbance of their passability, etc.
Forecast in cases of timely diagnosis and treatment favorable.
Bibliography: Anichkov M. N. and Lev I. D. Kliniko-anatomichesky atlas pathology of an aorta, L., 1967; B about about l e-p about in N. K., B at r d G. S. and Seleznyov A. N. Changes of a nervous system at a scalenus-anticus syndrome, Zhurn, a neuropath, and psikhiat., t. 74, No. 6, page 843, 1974; It is barefoot - N of e in V. Sindr a shoulder hand, the lane with bolg., Plovdiv, 1978, bibliogr.; To and p e r-in and with I. P. Neurovascular syndromes of a shoulder girdle and hands, M., 1975, bibliogr.; Pokrovsky A. V., etc. Efficiency of operation of crossing of a front scalene at a scalenus-anticus syndrome (a syndrome of a scalene), Zhurn, a neuropath, and psikhiat., t. 76, No. 8, page 1172, 1976; Sang yansky Ya. Yu. Cervical osteochondrosis, compression and reflex syndromes, page 136, M., 1966; Yu m and-sh e in G. S. Pi F at r m and M. E N. Osteochondroses of a backbone, M., 1973, bibliogr., Brain’s diseases of the nervous system, ed. 'by J. N. Walton, Oxford, 1977; N a f f z i-g e of of H. Page of a. G of of a n t W. T. Neuritis of the brachial plexus mechanical in origin, scalenus syndrome, Surg. Gynec. Obstet., at. 67, p. 722, 1938.
A. H. Seleznyov.