Overview: dorsal scapular nerve from the cervical nerve root with long thoracic nerve together dry nerves. Dorsal scapular nerve compression performance of the neck, shoulders, back, axilla, lateral chest wall pain and discomfort. Kevin (1993) reported that the dorsal scapular nerve closed treat neck and shoulder pain. In 1994, Song Chen a detailed report of the disease, and to propose surgical treatment, and achieved good results.[Cause]
(B) the pathogenesis
dorsal scapular nerve compression causes may have two aspects: first cervical nerve root, especially cervical nerve root compression and involvement as a branch of dorsal scapular nerve; another reason is. Dorsal scapular nerve passing in its pressure due to anatomical factors, such as through the middle scalene muscle fibers of the tendon of the start. Thus, the majority of dorsal scapular nerve compression in thoracic outlet syndrome exists, but can also stand alone.[Sign]
1. medical history and symptoms
(1) often made Symptoms: The disease is common in young women, all patients are neck and back discomfort, pain as the main symptoms. neck discomfort and weather, rainy days, the winter increase, fatigue could also be increased. upper arm extension, on the move, stretch the neck sense. neck and back pain so that patients often can not sleep, the patient is not comfortable with how to put conscious limb, but not clearly pointed out in pain.
2. signs and check the feeling in some patients may have diminished the forearm, a small number of patients with upper limb muscle strength, particularly shoulder abduction strength decreased. After the mid-point margin of sternocleidomastoid muscle and third thoracic spinous process 3,4 3cm there was tenderness at the point (Figure 2).
authors have treated 35 cases of patients with dorsal scapular nerve entrapment, male to female ratio of 9:26, in addition to 1 case of 52 years of age other than 34 patients at the age of 28 to 40 years old, average 35 years of age. Among them, 33 cases of unilateral disease, bilateral lesions in 2 cases, the right side in 26 cases, left in 16 cases. Duration of 4 months to 9 years. Now signs and checking summarized in table 1.
thoracic spinous process tenderness in the 3,4 point a little press, 27 patients complained of ipsilateral arm medial and ulnar hand discomfort, tingling. The tender point is closed, neck and hands are relaxed comfort. At the midpoint of the cervical posterior edge of sternocleidomastoid direction of compression, 4 patients with pain radiation to the sense of radial forearm and hand the radial side of the half. The point is closed, neck and back and hand pain, discomfort completely disappear. Oppression of the clavicle, the radial arterial pulse disappeared 31 cases.
dorsal scapular nerve entrapment syndrome is easily diagnosed as other diseases, this group of 27 patients had been misdiagnosed. Among them, the diagnosis of trapezius muscle strain, 10 cases of cervical disease in 8 cases, 6 cases of neurosis, frozen in 3 patients.
if neck pain, discomfort, passing along the dorsal scapular nerve tenderness. In particular, press 3, 4 thoracic spinous process can be induced by the ipsilateral upper extremity numbness, then the diagnosis can be established.[Aftertreat]
no relevant information.[Treat]
1. conservative treatment first consider conservative treatment to partial closure of the main. Closed point of two tender points (Figure 2), after the midpoint of one edge of the sternocleidomastoid muscle, the other is 3,4 thoracic spinous process 3cm. The authors suggest once a week for 3 to 6 times. Combined with physical therapy, half of the symptoms can be significantly reduced. 18 cases do 3 to 6 times a neck tenderness closed treatment, 6 patients with symptomatic significantly reduced; four cases improved, pain can be tolerated; nine cases ineffective, of which 7 cases were diagnosed underwent surgery.
2. surgical treatment of conservative treatment fails or symptoms of thoracic outlet syndrome associated with severe cases, surgery may be considered. Done under general anesthesia root of the neck transverse incision or "L"-shaped incision (Figure 3), cut off the transverse cervical artery ligation and omohyoid muscles, layer by layer dissection revealed brachial plexus root cadres and the former, the lower middle scalene muscle and stop point (Figure 4). Cut off the only point in the past before, the middle scalene muscle, nerve cut along the neck 5 cervical nerve root of the surrounding fibrous tissue, and further in the scalene muscle in the neck 5 nerve roots organization run amok off, exposing dorsal scapular nerve, cut off the nerves surrounding tissue, making nerve membrane lysis (Figure 5,6). Incision is closed before the local injection of triamcinolone acetonide 5ml. Available after prednisone 5mg, 3 times / d, a total of 7 days.
surgery can be seen: the beginning part of dorsal scapular nerve to go in the middle scalene muscle in the line 1 ~ 3cm, can clearly determine the starting point of dorsal scapular nerve, dorsal scapular nerve in the people who are at the scalene muscle tendon or tendon tissue. Author of 23 patients who have surgery treatment side 25, side 2 Example 3 except the beginning part of dorsal scapular nerve a little coverage in the scalene muscle fiber, the remaining part of the walking surface in the middle scalene muscle; two cases in the oblique side 3 angle intramuscular traveling l ~ 2cm; 18 Example 19 side to walk the ramp in the middle scalene muscle line of 2 ~ 3cm; which 17 side can clearly determine the starting point dorsal scapular nerve, of which three are independent starting point side, 14 side of the long thoracic and neck 5 nerve together dry, together dry 1cm in length by 4 side, 1 ~ 4cm, 10 side; 22 cases of 24 side of the dorsal scapular nerve in people who are at the scalene muscle tendon or tendon tissue. Subclavian artery in this group of patients a higher position, higher than the upper edge of the clavicle in 18 cases, up to the upper edge of the clavicle 4 ~ 5cm, the highest one case up to 6cm, an average of 3.5cm.
(b) the prognosis
short-term effect of conservative treatment is better, but easy to relapse, 3 to 6 times the neck recurrence rate after partial closure is still 50%. An interval of 2 to 3 months after the partial closure of a course of treatment.
22 patients were completely or most of the neck, shoulder, back symptoms disappear. After 3 days, the patient may feel discomfort and preoperative another similar, but the symptoms gradually reduced after 1 week, 3 weeks after the symptoms most or completely disappear. Up from 3 months to 2 years, 3 cases of 4 side 2 months after surgery, symptoms, signs appeared, with the preoperative level. Which, without making the dorsal scapular nerve decompression at the beginning of the 2 sides of 1 case of bilateral thoracic outlet syndrome, 3 days after symptoms appear and gradually increase again, after more than a year when not more; the other 2 sides pressure for the postoperative scar, the partial closure, the current can still control the symptoms. Inside of the forearm and the little finger sensory loss in 16 patients, postoperative symptoms were significantly improved after 3 days there are fluctuations, 2 to 3 weeks after the gradual return to normal.
1. electromyography supraspinatus, infraspinatus muscle, deltoid and rhomboid muscle showed no abnormality, 7 cases of the first dorsal interosseous muscle and little finger abductor has fibrillation potentials, rhomboid muscle and may not check the location and depth. Nerve conduction velocity were normal.
currently no related information[Disease]
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