• Monday May 25,2020


Scale syndrome is a nerve compression syndrome that is one of the thoracic outlet syndromes. In the syndrome, the brachial plexus becomes jammed in the scleral gap between the muscular scalenus anterior and medius muscles. In neurological deficits, a surgical release of the compressed nerve.

What is the scalene syndrome?

The so-called bottleneck syndromes are a group of compression syndromes. By the compression syndromes the medicine understands illnesses, which go back to the jamming of an anatomical structure in a certain bottleneck of the body.

Scaleness syndrome is a nerve compression syndrome in which the brachial plexus of the brachial plexus is jammed in the so-called "scalenus gap". The scalenus anterior muscle is a muscle between the cervical vertebrae and the ribs that, under certain circumstances, may narrow the nerve network in its course. Scalesus syndrome is also called cervical ribose syndrome or Naffziger syndrome.

Meanwhile, the disease is summarized under the broader term Thoracic outlet syndrome. These syndromes are upper chest neurovascular compression syndromes. Other nerve compression syndromes from this disease group are hyperabduction syndrome, pectoralis minor syndrome, Paget-von-Schroetter syndrome, and the costoclavicular syndrome. An exact prevalence for the scalene syndrome is not known. Overall, thoracic outlet syndromes are considered relatively common.


The cause of the scalene syndrome is a compression of the brachial plexus. This network of nerves of the arm runs along the arms, shoulders and chest. The scalenus anterior muscle runs between the cervical vertebrae and the ribs. The area between the scalenus anterior muscle and the scalneus medius muscle is also known as the scalenus gap.

This site is a bottleneck for the brachial plexus, especially if the patient has an extra cervical rib. Additional cervical ribs are thus considered one of the most common causes of the scalene syndrome. However, the cause of the syndrome does not necessarily have to be due to a supernumerary bony element, but may also be related to the muscle itself. For example, the muscle may be affected by muscle hypertrophy.

The resulting oversize of muscle tissue can also force the brachial plexus into tight space. Another cause is a rise or exostosis of the upper ribs, which can result in a severely narrowed scale gap. In the latter case, in addition to the strands of the brachial plexus, strands of the subclavian artery are also affected by compression. In some circumstances, compression may also be associated with an overly pronounced ligamentous apparatus.

Symptoms, complaints & signs

The brachial plexus innervates the shoulder and chest muscles and is involved in motor and sensory innervation of the arm and hand. For this reason, patients with dialect syndrome typically suffer from exercise-related neuralgic pain in the shoulder and arm, manifesting predominantly around the ulnar forearm.

Because the sensory innervation of the hand is disturbed due to nerve compression, hypoaesthesia or paresthesia occurs in the hand. These emotional disorders are in some cases associated with intermittent circulatory disorders, especially with concomitant compression of the subclavian artery. Due to these circulatory disorders, the affected person increasingly falls asleep the affected arm.

In part, a numbness and heaviness occurs. In the later stage of a scalene syndrome, the patient may complain of paralysis of the arm and chest muscles, as the muscles in this area are motor innervated by the compressed brachial plexus. From a certain stage, atrophy-induced atrophy of the musculature is also conceivable, especially the small hand muscles.

By narrowing the subclavian artery in the advanced stage of the syndrome even the smallest clots, which may close the finger vessels and thus lead to a discoloration of the fingers.

Diagnosis & disease course

The diagnosis of a scalene syndrome is usually made by the doctor by provocation test. Imaging of the thorax may also be required as a diagnostic tool. The differential diagnosis requires the physician to differentiate the syndrome from other thoracic outlet syndromes. The prognosis for patients with dialect syndrome is generally favorable.


Patients with dialect syndrome typically suffer from exercise-related shoulder and arm pain. These are usually associated with emotional disorders and circulatory disorders, which can lead, for example to movement restrictions and rarely to the formation of blood clots. In the later stages of the disease atrophies of the muscles can be added.

Affected are especially the small hand muscles, which are less efficient due to the tissue loss and considerably limit the affected person in the daily tasks. As the disease progresses, neurological deficits such as paralysis and movement disorders also occasionally appear. If these symptoms remain untreated, permanent damage to the compressed nerve tissue can be left behind. In addition, it comes to thrombosis, which close the finger vessels and lead to a discoloration of the fingers.

In pain therapy, the individual drugs can cause side effects and may also cause major complications. If local anesthetics are injected, it can theoretically lead to poisoning of the surrounding tissue. This is associated with nervousness, dizziness and seizures. Lower blood pressure and cardiac arrhythmias can also be noticed in rare cases. Surgical intervention involves the usual risks: infections, bleeding, nerve injuries and wound healing disorders.

When should you go to the doctor?

With the scalene syndrome a medical treatment is always necessary. In most cases, it can lead to significant limitations and complaints in everyday life. The scalene syndrome does not heal on its own. For this reason, it is advisable to consult a physician at the first sign who can alleviate these symptoms. A doctor should visit when the person is suffering from severe pain in the arms or shoulders. This pain usually occurs for no particular reason and has a very negative effect on the movement and also on the quality of life of the person concerned.

In many cases, disorders of the circulation or emotional disorders also indicate the scalene syndrome and should also be examined by a doctor. Also, numbness may indicate the Skalenussyndrom. Furthermore, a doctor is then to visit, when it comes to the formation of blood clots. The scalene syndrome can be detected and treated by a GP or by an orthopedist.

Treatment & Therapy

With scale syndromes of mild severity, no further therapy is often necessary. The treatment in this case focuses primarily on the alleviation of pain symptoms. Such mitigation can be achieved by conservative drug treatment of the patient. But most of the time it is important to avoid the pain-inducing strains. The patient does not need to be unnecessarily treated with analgesics.

With pronounced pain symptoms, the pain is usually reduced by means of pain therapy. As such, for example, local infiltration of the affected muscle with a local anesthetic in question. This local therapeutic anesthetic may also be delivered by an implant that regularly delivers local anesthetics to the muscle.

If symptoms are present in addition to the pain symptoms, a pain therapy for the treatment of the scalene syndrome is not enough. This is especially true when neurological deficits appear like paralyzes. To restore the patient's ability to move, a surgical intervention may be indicated. The intervention should be carried out before lasting damage to the compressed nerve network.

Surgical intervention resolves the primary cause of compression. For example, this therapy step often corresponds to the surgical removal of an additional cervical rib.


The econometric syndrome can not be prevented in the narrower sense, since the syndrome is sometimes the most common result of excess cervical ribs. Such supernumerary cervical ribs are innate and can not be avoided by active steps. However, the pain syndrome of the syndrome can be prevented so far as that pain-generating stress can be avoided.


In most cases, the options and the measures of follow-up on the scale syndrome are clearly limited. In any case, the patient is dependent on a rapid and above all on an early diagnosis and treatment of this disease so that it does not come to complications or other complaints in the further course. The earlier a scalp syndrome is consulted, the better the outcome of the disease is generally better.

Most sufferers are dependent on the measures of physiotherapy and physiotherapy in Skalenussyndrom. In doing so, some of the exercises from these therapies can be repeated in one's own home, which speeds up healing. Similarly, in many cases, the use of various medications is necessary to relieve the symptoms.

The affected person should always pay attention to the prescribed dosage and regular intake. If there is a wish for a child, a genetic examination and counseling can be carried out. This can prevent the recurrence of this disease. Further measures of aftercare are usually not available to the person concerned.

You can do that yourself

In everyday life, care must be taken to avoid situations of physical strain. The body should be protected from overuse. To support the muscular system, it is recommended to use massages or regular warm baths. If there are restrictions on movement possibilities, physiotherapeutic treatments are carried out. The affected person can also carry out independently learned exercises and training sessions to improve his or her own health outside the specified therapy times.

Since there may be a development of thrombosis, disorders of the blood circulation should be prevented at an early stage. Rigid postures should therefore not be taken. If there are sensory disturbances of the skin or a tingling sensation on the skin, compensation movements must be carried out immediately. Overall, sufficient exercise helps to strengthen the immune system and stimulate the bloodstream.

Characteristic of the Skalenussyndrom is an intense pain development. Although these conditions are treated medically, many patients have found that strengthening the mental area can alleviate pain perception. Therefore, it is advisable to try out methods such as mental training, yoga or autogenic training. The techniques of the relaxation methods described can also be independently and independently involved at all times in everyday life of the person concerned. In addition, cognitive patterns are optimized, making it easier to deal with the disease.

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