Characteristics of the syndrome
The vessels and nerves that go to the arms and are located between the muscles of the neck (the scalenus anterior and the scalenus medius muscles) and the first rib are compressed, causing numbness in the arms, fatigue and weakness. In addition, lifting or stretching the arms causes pain in the shoulders, arms and back. In some instances, it is mainly the nerves that become compressed; in others, it is the arteries. In both cases, there is some improvement after removal of the first rib and the scalenus muscles. When the nerves are involved, compression may occur either below or above the neck. The location of this compression must be diagnosed correctly before surgery.
Diagnosis
Numbness occurs when the arms are lifted. With the vascular type, the hands become pale after they are raised, and the blood vessels at the wrist cannot be felt by touch. When the hands are lowered, they quickly regain color and are back to normal after a few minutes. It is fairly easy to recognize vascular compression with an x-ray picture of the arteries (Fig. 46). With nerve involvement, pain and numbness are both experienced, and when the hands are raised these feelings intensify. There is no strength in the hands, and the patient tends to drop objects from her grasp.
Fig. 46Treatment
There is a surgical technique for removal of the first rib through a cross section at the armpit, but there are some cases in which this does not eliminate compression, and it is quite common for the compression to reappear again over time. It has recently been concluded that the possibility of a relapse can best be reduced by removing both the first rib and the base of the scalenus muscle through a cut 7 to 8 cm above the collar bone. This surgery produces extremely satisfactory results. For nerve compression, except when the nerve becomes strangled in the small space between the scalenus muscles (such as when it is compressed by a ligament), the cross section should be approximately 10 cm.