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As a treatment for exercise-induced scalenus syndrome, scalenectomy can allow professional athletes to return to full activity relatively quickly, according to a case series reported by Greek researchers.

by Scott Baltic

As a treatment for exercise-induced scalenus syndrome, scalenectomy can allow professional athletes to return to full activity relatively quickly, according to a case series reported by Greek researchers in the February issue of the American Journal of Sports Medicine.

The researchers reported on 12 professional athletes (mean age 27.9 years, range 17 to 46) who were examined between 1993 and 2004 for various upper extremity symptoms that indicated possible thoracic outlet syndrome. Eight cases were entirely neurologic in nature, while four were a combination of vascular and neurologic thoracic outlet syndrome. Four patients had bilateral involvement.

Symptoms of neurologic thoracic outlet syndrome included pain, paresthesia, loss of dexterity and muscle weakness. Symptoms of vascular thoracic outlet syndrome included pain, swelling, stiffness in the fingers and a feeling of heaviness.

Diagnosis of scalenus anticus syndrome was based on patient histories, clinical findings (including the Adson test, which was positive in all cases) and imaging, including radiographs, MRI, EMG and CT. In all 12 cases included in this series, symptoms were severe and not amenable to nonoperative management.

Because the patients were high-level athletes (two competed post-operatively in the Olympic Games), the researchers write, "exercise was suspected to be the underlying pathophysiologic mechanism of scalenus muscle hypertrophy as there was no other objective finding responsible for neurovascular compression."

The surgical approach in all cases was the supraclavicular technique with approximately 1 cm reduction in width of the anterior scalene muscle. Moderate to severe hypertrophy of the anterior scalene muscle was confirmed in all cases. Post-operative treatment included physical therapy, and follow-up examinations were conducted at three, six and 12 months, with total follow-up going to three 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 and athletic activities, and no relapses were reported.

Rowing, wrestling, judo and javelin are among the sports that can lead to anterior scalene muscle hypertrophy, co-author George Prionas of the University of Athens explained to Reuters Health. "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."

Although Prionas said he would recommend the surgical option for elite athletes, he suggested that 'normal' people could try a conservative approach first.


Source: Reuters