The scalenes are about múmuscles located on the front of the neck, since they are great protagonists in the treatment of (about) the 80-90% of the cases we treat in our center.
These múscules present a dysfunctionón (raised tone, myofascial trigger points, tense bands, contractures, shortening, etc…) very often, dada su situationón goneómica (now we will give brushstrokes on its anatomyía), its functionóno respiratory, and its alterationón before stress processesés.
Index
Anatomy of the múscalene centuries
The Múscalene sicles are located in the anterior zone, on the sides of the neck. East án formed by three pair groups of múdogs, anterior scalene, middle scalene and posterior scalene.
The scalenes originate from the vértebras cervicales, from C2 to C7, and they will insert on the first and second ribs.
The functionóIt will not depend on the group we are talking about. The middle and anterior scalenes are going to be in charge of making inclinationólateral n to the same side and rotationón to the opposite side, además, they elevate the first rib being múinspirational accessories. Posterior scalenes tilt and rotate to the same side and elevate the second rib.
Además, if this musculature is altered and ends up ascendingéat 1º o 2º rib, it is possible that it ends up affecting the subclavicular space, and everything that passes through this space, especially the subclavian artery and vein.
It is important to know that it is directly related to the brachial plexus because it passes between the anterior and middle scalenes. the nerve frénico passes in front of the anterior and the first rib
Alterations of the scalene
Alterations such as tensionón, increased tone or trigger points in these múmuscles can cause compressionón, for the decreaseóno of space, of the neurovascular bundle (produceégetting an entrapment or “constriction” of the set of nerves and vessels that, jointly, pass through planes of the body, and body tissues) what happens between them, previously named, and that is in charge of the innervationón and vascularityón of the entire upper limb. Therefore, this means that the limb ipsilateral to the affected side will haveá a less blood supplyíneo and impaired drivingón nervous.
The agents that produce this alterationón can be diverse, such as, adaptations in the thoracic and cervical spine, work overload, strés, sustained postures and repetitive movements, wrong rest etc.
There will be certain postures and movements that affect myáonly to this musculature, for example, sitting down for long hours, long car trips, machining worksóno on computer, etc…
Además, a strong relationship has been demonstratedón between this musculature and anxiety and stress problemsés (especially when it becomes chronic and is maintained over time), and with respiratory problems, since they are múaccessory muscles on inspirationón ( and in stress processeséit's high tooéwe will not have a breathón changed).
SÍNTOMAS
They do not usually create limitations in the mobility of the functions performedñstill in these múmuscles can give referred pain in the arms forearms, fingers, chest and escáanyway. Así well, we can notice numb or tingling fingers (fake síndromes de túin them carpians), arm muscle weakness and difficulty with movement, cervical pain, pain radiating to the chest, fatigue, upper limb heaviness, clumsiness in digital movements and pressureón even dizziness.
The intensity of all thoseísymptoms will depend on the degree of the lesionón and compression levelón. The síSymptoms usually manifest in the early hours of the morning.ñana and can wake the patient during the night.
TREATMENT
First, the objective that we must address in the physiotherapy treatmentéuse of this síscalene syndrome, must be to identify and eliminate the agents that cause excessive stressón muscular, since recovering normal muscle tone recoverílove the natural space between the muscle bellies and avoidíI love compressionón of the neurovascular bundle. In the explorationódon't know how to identifyá the possible alterations or adaptations of the spine that can cause the lesionón and will be usedá to correct theméosteop techniquesátics and physiotherapyápizzas.
To continue promoting relaxationón muscular, we will continue with manual therapy on trigger points and tight bands, deliver usón miofascial…These Tétechniques do not applyán only on the scalenes, yes not tooén in the múthe dogs that isán directly related as for example the pectoralis minor, trapezius and arm muscles that may be overloaded by the alterationón of the plexus.
Finally, stretching is important, putting more emphasisé on middle and anterior scalenes.
Además, you can toñadd neurodynamics to restore physiological glideólogic of the nerves involved, how are the median nerve, ulnar and radial.
To beá It is essential to educate and send stretches so that the patient can do them at home, to be able to maintain the results that we have achieved with the tétechniques applied during the sessionón.
To get that treatment sesióIf physiotherapy is prolonged over time, a neuromuscular bandage can be placed in a complementary way.
