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Artykuły w czasopismach na temat „Scalene”

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Data publikacji: 4 czerwca 2021

Data aktualizacji: 1 lutego 2022

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1

De Troyer, A., M. Cappello i J. F. Brichant. "Do canine scalene and sternomastoid muscles play a role in breathing?" Journal of Applied Physiology 76, nr 1 (1.01.1994): 242–52. http://dx.doi.org/10.1152/jappl.1994.76.1.242.

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To assess the respiratory function of the scalene and sternomastoid muscles in the dog, we studied the effect of graded increases in inspiratory airflow resistance and single-breath airway occlusion on the electrical activity of these muscles in 18 supine anesthetized spontaneously breathing animals. The sternomastoids never showed any activity, and the scalenes showed some inspiratory activity during occlusion in only two animals. The adoption of the prone position and bilateral cervical vagotomy did not affect this pattern. Hypercapnia also did not elicit any sternomastoid activity and induced scalene inspiratory activity during occlusion in only four of nine animals. On microscopic examination, however, both muscles were found to contain large numbers of spindles, suggesting that they have the capacity to respond to stretch. In addition, with increases in inspiratory resistance, both the sternum and ribs were displaced in the caudal direction. As a result, the scalenes demonstrated a gradual inspiratory lengthening and the normal inspiratory lengthening of the sternomastoids was accentuated. Additional studies in three unanesthetized animals showed consistent activity in the scalene and sternomastoid muscles during movements of the trunk and neck but no activity during breathing, including occluded breathing. These observations thus indicate that the alpha-motoneurons of the scalene and sternomastoid muscles in the dog have very small central respiratory drive potentials with respect to their critical firing threshold. In this animal, these muscles do not have a significant respiratory function.

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2

Takenaga, Tetsuya, Satoshi Takeuchi, Hideki Murakami, Katsumasa Sugimoto i Masahito Yoshida. "Throwing can Increase the Stiffness of the Scalene Muscle". Orthopaedic Journal of Sports Medicine 8, nr 7_suppl6 (1.07.2020): 2325967120S0040. http://dx.doi.org/10.1177/2325967120s00402.

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Objectives: Thoracic outlet syndrome (TOS) has been reported as a set of symptoms due to the compression of the brachial plexus and subclavian vessels in the region of the thoracic outlet1. As a type of TOS, scalenus anticus syndrome involves the compression of the brachial nerves as they pass through the interval surrounded by the anterior and middle scalene muscles, and the first rib bone or cervical rib2. Recently, exercise-induced TOS is becoming more common in athletes, especially for those who perform repetitive overhead and hyperabduction maneuvers with upper limbs, such as baseball players. However, the effect of throwing on the stiffness of the scalene muscles is unknown. Thus, the purpose of this study was to quantitatively measure the stiffness of the scalene muscles using real-time shear wave elastography (SWE). The stiffness of scalene muscles was hypothesized to increase for the throwing side of baseball players. Methods: Thirty college baseball players (age range 19 to 21 years) were included for this study. Ultrasonic SWE with a 2-10 MHz linear array probe transducer (Aixplorer; SuperSonic Imagine, Aix-en-Provence, France) was used to assess the stiffness of the anterior and middle scalene muscles. Each participant was sited. The measurements were performed in two arm positions; 1) adducted and neutral rotation of the shoulder 2)90 degree of abduction and external rotation of shoulder with elbow flexed to simulate a clinical examination known as Roos test3. In both of the arm positions, the transducer was positioned just superior to the clavicular bone, parallel to its axis. Transducer was moved superiorly and tilted to visualize the superior surfaces of the anterior and middle scalene muscles parallel to the surface of the fifth cervical nerve simultaneously (Figure 1A). In this position, shear wave elastography was performed to measure the elasticity of each scalene muscle as its stiffness. Each muscle was divided into superior and deep areas. In both areas of each muscle, three 3mm-diameter circles were set to measure the elasticities of the scalene muscles and its averaged data in each area was defined as each stiffness (Figure 1B). A repeated-measures analysis of variance (ANOVA) was used to compare the elasticity of superior and deep areas in anterior and middle scalene muscles in throwing and non-throwing side. Values of p<0.05 were considered statistically significant. Results: For the throwing side, higher stiffness was found in the deep part of the middle scalene muscle compared to the superior and deep parts of the anterior scalene muscle with an adducted and neutrally rotated shoulder (p=0.0433). Moreover, the muscle stiffness was significantly higher in the superior and deep part of the middle scalene muscle than in the superior and deep parts of anterior scalene muscle in an abducted and externally rotated position of shoulder (p =0.00187). Meanwhile, no significant difference was found in the anterior and middle scalene muscles for the non-throwing side in both arm positions. Conclusion: In professional athletes with TOS who experienced surgical treatment, moderate to severe hypertrophy of the anterior scalenus muscles has been reported to be found4. Meanwhile, although the stiffness of the scalene muscles can be also related to the compression on the brachial plexus and on subclavian vessels in the region of the thoracic outlet, its quantitative measurements in the scalene muscles has not been reported. In this study, at throwing side, the muscle stiffness significantly increased in the superior area of middle scalene muscle in throwing side. While no contribution was identified in the scalene muscles at non-throwing side. As a result, repeat throwing motion can increase the stiffness of the middle scalene muscle. As a result, the brachial plexus and/or the subclavian artery could be compressed at the interscalene triangle. Throwing athletes with TOS should be treated, considering the stiffness of the middle scalene muscle, even conservative or surgical treatment. Our study was the first study to evaluate the effects of throwing on the stiffness of the scalene muscles in throwing athletes. Repetitive throwing motion can affect the stiffness of middle scalene muscle. Reduction of the middle scalene muscle should be considered to treat throwing athlete who has TOS. [Figure: see text]

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3

Boran, Nurettin, Fulya Kayikçioğrlu, Gokhan Tulunay i M. Faruk Kose. "Scalene Lymph Node Dissection in Locally Advanced Cervical Carcinoma: Is it Reasonable or Unnecessary?" Tumori Journal 89, nr 2 (marzec 2003): 173–75. http://dx.doi.org/10.1177/030089160308900213.

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Aims and background The aim of this study was to evaluate the routine use of scalene lymph node dissection to determine the degree of disease spread in women with stage IIB-IVA cervical cancer treated at our hospital. Methods and study design Patients with locally advanced cervical carcinoma underwent para-aortic lymph node dissection via the extraperitoneal approach. Patients with clinical evidence of scalene or supraclavicular node metastasis were excluded. If their paraaortic nodes were tumor-positive, patients underwent scalene lymph node dissection. Results Twenty-eight scalene lymph node samplings were performed. Three patients had microscopically positive scalene lymph nodes (10.7%). In one patient the thoracic duct was injured. Conclusion Patients with cervical carcinoma whose only extrapelvic site of metastases is the para-aortic lymph nodes may be eligible for scalene lymph node dissection as part of their pretreatment assessment, especially if extended field radiation is considered.

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4

Legrand, Alexandre, Melanie Majcher, Emma Joly, Adeline Bonaert i Pierre Alain Gevenois. "Neuromechanical matching of drive in the scalene muscle of the anesthetized rabbit". Journal of Applied Physiology 107, nr 3 (wrzesień 2009): 741–48. http://dx.doi.org/10.1152/japplphysiol.91320.2008.

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The scalene is a primary respiratory muscle in humans; however, in dogs, EMG activity recorded from this muscle during inspiration was reported to derive from underlying muscles. In the present studies, origin of the activity in the medial scalene was tested in rabbits, and its distribution was compared with the muscle mechanical advantage. We assessed in anesthetized rabbits the presence of EMG activity in the scalene, sternomastoid, and parasternal intercostal muscles during quiet breathing and under resistive loading, before and after denervation of the scalene and after its additional insulation. At rest, activity was always recorded in the parasternal muscle and in the scalene bundle inserting on the third rib (medial scalene). The majority of this activity disappeared after denervation. In the bundle inserting on the fifth rib (lateral scalene), the activity was inconsistent, and a high percentage of this activity persisted after denervation but disappeared after insulation from underlying muscle layers. The sternomastoid was always silent. The fractional change in muscle length during passive inflation was then measured. The mean shortening obtained for medial and lateral scalene and parasternal intercostal was 8.0 ± 0.7%, 5.5 ± 0.5%, and 9.6 ± 0.1%, respectively, of the length at functional residual capacity. Sternomastoid muscle length did not change significantly with lung inflation. We conclude that, similar to that shown in humans, respiratory activity arises from scalene muscles in rabbits. This activity is however not uniformly distributed, and a neuromechanical matching of drive is observed, so that the most effective part is also the most active.

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5

Legrand, Alexandre, Emmanuelle Schneider, Pierre-Alain Gevenois i André De Troyer. "Respiratory effects of the scalene and sternomastoid muscles in humans". Journal of Applied Physiology 94, nr 4 (1.04.2003): 1467–72. http://dx.doi.org/10.1152/japplphysiol.00869.2002.

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Previous studies have shown that in normal humans the change in airway opening pressure (ΔPao) produced by all the parasternal and external intercostal muscles during a maximal contraction is approximately −18 cmH2O. This value is substantially less negative than ΔPao values recorded during maximal static inspiratory efforts in subjects with complete diaphragmatic paralysis. In the present study, therefore, the respiratory effects of the two prominent inspiratory muscles of the neck, the sternomastoids and the scalenes, were evaluated by application of the Maxwell reciprocity theorem. Seven healthy subjects were placed in a computed tomographic scanner to determine the fractional changes in muscle length during inflation from functional residual capacity to total lung capacity and the masses of the muscles. Inflation induced greater shortening of the scalenes than the sternomastoids in every subject. The inspiratory mechanical advantage of the scalenes thus averaged (mean ± SE) 3.4 ± 0.4%/l, whereas that of the sternomastoids was 2.0 ± 0.3%/l ( P < 0.001). However, sternomastoid muscle mass was much larger than scalene muscle mass. As a result, ΔPao generated by a maximal contraction of either muscle would be 3–4 cmH2O, which is about the same as ΔPao generated by the parasternal intercostals in all interspaces.

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6

Legrand, Alexandre, Vincent Ninane i André De Troyer. "Mechanical advantage of sternomastoid and scalene muscles in dogs". Journal of Applied Physiology 82, nr 5 (1.05.1997): 1517–22. http://dx.doi.org/10.1152/jappl.1997.82.5.1517.

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Legrand, Alexandre, Vincent Ninane, and André De Troyer. Mechanical advantage of sternomastoid and scalene muscles in dogs. J. Appl. Physiol. 82(5): 1517–1522, 1997.—Theoretical studies have led to the prediction that the maximal effect of a given respiratory muscle on airway opening pressure (Pao) is the product of muscle mass, the maximal active muscle tension per unit cross-sectional area, and the fractional change in muscle length per unit volume increase of the relaxed chest wall. It has previously been shown that the parasternal intercostals behave in agreement with this prediction (A. De Troyer, A. Legrand, and T. A. Wilson. J. Physiol. (Lond.) 495: 239–246, 1996; A. Legrand, T. A. Wilson, and A. De Troyer. J. Appl. Physiol. 80: 2097–2101, 1996). In the present study, we have tested the prediction further by measuring the response to passive inflation and the pressure-generating ability of the sternomastoid and scalene muscles in eight anesthetized dogs. With 1-liter passive inflation, the sternomastoids and scalenes shortened by 2.03 ± 0.17 and 5.98 ± 0.43%, respectively, of their relaxation length ( P < 0.001). During maximal stimulation, the two muscles caused similar falls in Pao. However, the sternomastoids had greater mass such that the change in Pao (ΔPao) per unit muscle mass was −0.19 ± 0.02 cmH2O/g for the scalenes and only −0.07 ± 0.01 cmH2O/g for the sternomastoids ( P < 0.001). After extension of the neck, there was a reduction in both the muscle shortening during passive inflation and the fall in Pao during stimulation. The ΔPao per unit muscle mass was thus closely related to the change in length; the slope of the relationship was 3.1. These observations further support the concept that the fractional changes in length of the respiratory muscles during passive inflation can be used to predict their pressure-generating ability.

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7

Fournier, Mario, i Michael I. Lewis. "Functional, cellular, and biochemical adaptations to elastase-induced emphysema in hamster medial scalene". Journal of Applied Physiology 88, nr 4 (1.04.2000): 1327–37. http://dx.doi.org/10.1152/jappl.2000.88.4.1327.

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The scalene has been reported to be an accessory inspiratory muscle in the hamster. We hypothesize that with the chronic loads and/or dynamic hyperinflation associated with emphysema (Emp), the scalene will be actively recruited, resulting in functional, cellular, and biochemical adaptations. Emp was induced in adult hamsters. Inspiratory electromyogram (EMG) activity was recorded from the medial scalene and costal diaphragm. Isometric contractile and fatigue properties were evaluated in vitro. Muscle fibers were classified histochemically and immunohistochemically. Individual fiber cross-sectional areas (CSA) and succinate dehydrogenase (SDH) activities were determined quantitatively. Myosin heavy chain (MHC) isoforms were identified by SDS-PAGE, and their proportions were determined by scanning densitometry. All Emp animals exhibited spontaneous scalene inspiratory EMG activity during quiet breathing, whereas the scalene muscles of controls (Ctl) were silent. There were no differences in contractile and fatigue properties of the scalene between Ctl and Emp. In Emp, the relative amount of MHC2Awas 15% higher whereas that of MHC2X was 14% lower compared with Ctl. Similarly, the proportion of type IIa fibers increased significantly in Emp animals with a concomitant decrease in IIx fibers. CSA of type IIx fibers were significantly smaller in Emp compared with Ctl. SDH activities of all fiber types were significantly increased by 53 to 63% in Emp. We conclude that with Emp the actively recruited scalene exhibits primary-like inspiratory activity in the hamster. Adaptations of the scalene with Emp likely relate both to increased loads and to factors intrinsic to muscle architecture and chest mechanics.

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8

Estenne, M., M. Gorini, A. Van Muylem, V. Ninane i M. Paiva. "Rib cage shape and motion in microgravity". Journal of Applied Physiology 73, nr 3 (1.09.1992): 946–54. http://dx.doi.org/10.1152/jappl.1992.73.3.946.

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We studied the effect of microgravity (0 Gz) on the anteroposterior diameters of the upper (URC-AP) and lower (LRC-AP) rib cage, the transverse diameter of the lower rib cage (LRC-TR), and the xiphipubic distance and on the electromyographic (EMG) activity of the scalene and parasternal intercostal muscles in five normal subjects breathing quietly in the seated posture. Gastric pressure was also recorded in four subjects. At 0 Gz, end-expiratory LRC-AP and xiphipubic distance increased but LRC-TR invariably decreased, as did end-expiratory gastric pressure. No consistent effect was observed on tidal LRC-TR and xiphipubic displacements, but tidal changes in URC-AP and LRC-AP were reduced. Although scalene and parasternal phasic inspiratory EMG activity tended to decrease at 0 Gz, both muscle groups demonstrated an increase in tonic activity. We conclude that during brief periods of weightlessness 1) the rib cage at end expiration is displaced in the cranial direction and adopts a more circular shape, 2) the tidal expansion of the ventral rib cage is reduced, particularly in its upper portion, and 3) the scalenes and parasternal intercostals generally show a decrease in phasic inspiratory EMG activity and an increase in tonic activity.

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9

Nguyen, Vuvi H., Hao (Howe) Liu, Armando Rosales i Rustin Reeves. "A Cadaveric Investigation of the Dorsal Scapular Nerve". Anatomy Research International 2016 (15.08.2016): 1–5. http://dx.doi.org/10.1155/2016/4106981.

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Compression of the dorsal scapular nerve (DSN) is associated with pain in the upper extremity and back. Even though entrapment of the DSN within the middle scalene muscle is typically the primary cause of pain, it is still easily missed during diagnosis. The purpose of this study was to document the DSN’s anatomy and measure the oblique course it takes with regard to the middle scalene muscle. From 20 embalmed adult cadavers, 23 DSNs were documented regarding the nerve’s spinal root origin, anatomical route, and muscular innervations. A transverse plane through the laryngeal prominence was established to measure the distance of the DSN from this plane as it enters, crosses, and exits the middle scalene muscle. Approximately 70% of the DSNs originated from C5, with 74% piercing the middle scalene muscle. About 48% of the DSNs supplied the levator scapulae muscle only and 52% innervated both the levator scapulae and rhomboid muscles. The average distances from a transverse plane at the laryngeal prominence where the DSN entered, crossed, and exited the middle scalene muscle were 1.50 cm, 1.79 cm, and 2.08 cm, respectively. Our goal is to help improve clinicians’ ability to locate the site of DSN entrapment so that appropriate management can be implemented.

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10

Farkas, G. A., i D. F. Rochester. "Contractile characteristics and operating lengths of canine neck inspiratory muscles". Journal of Applied Physiology 61, nr 1 (1.07.1986): 220–26. http://dx.doi.org/10.1152/jappl.1986.61.1.220.

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The neck inspiratory muscles are recruited to support breathing under numerous conditions. To gain insight into their synergistic actions we examined the isometric contractile properties of bundles from canine scalene and sternomastoid muscles. In addition, we also related the length of the neck muscles, measured sonomicrometrically in vivo at different lung volumes and body positions, to their optimal force-producing length (Lo) determined in vitro. We found that the speed of the sternomastoid is somewhat faster than that of the scalene owing to a shorter relaxation rate; the sternomastoid generates higher forces at submaximal stimulation frequencies than the scalene; the maximal tetanic force corrected for cross-sectional area is the same for both neck muscles; the neck muscles are significantly faster than the canine costal diaphragm; at supine functional residual capacity (FRC), the scalene is operating at a length corresponding to 85% Lo, whereas the sternomastoid is significantly shorter at 75% Lo; increasing lung volume shortens both muscles slightly, the length at supine total lung capacity being approximately 5% shorter than at FRC; and in the upright posture, both neck muscles lengthen toward their Lo, with the sternomastoid lengthening more than the scalene. We conclude that the scalene is a more effective force generator than the sternomastoid with the animal lying supine; the neck muscles appear to maintain their force-generating potential regardless of the lung volume; and the force-generating potential of the neck muscles is greatly enhanced with the animal in the upright vs. the supine position. This may contribute to the augmented rib cage motion characteristic of breathing in the upright posture.

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11

Plunkett, P. K. "Inter-scalene brachial plexus blocks." Emergency Medicine Journal 7, nr 2 (1.06.1990): 122. http://dx.doi.org/10.1136/emj.7.2.122-a.

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12

Stjernberg, N., H. Truedson i H. Björnstad-Petersen. "Scalene Node Biopsy in Sarcoidosis". Acta Medica Scandinavica 207, nr 1-6 (24.04.2009): 111–13. http://dx.doi.org/10.1111/j.0954-6820.1980.tb09686.x.

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13

Monsivais, Jose, Yang Sun i T. Rajashekhar. "The Scalene Reflex: Relationship Between Increased Median or Ulnar Nerve Pressure and Scalene Muscle Activity". Journal of Reconstructive Microsurgery 11, nr 04 (lipiec 1995): 271–75. http://dx.doi.org/10.1055/s-2007-1006543.

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14

Popelansky, Ya Yu, i O. N. Markov. "Stimulation electroneuromyography of the middle scalene syndrome". Neurology Bulletin XXXII, nr 1-2 (15.05.2000): 42–46. http://dx.doi.org/10.17816/nb77770.

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With the purpose of making diagnostics of the middle scalene syndrome more differentiated, neuromyographic evalution of neuromuscular complex (nervus thoracicus longus ... musculus serratus anterior) has been performed. In 33 patients with the middle scalene syndrome and in 11 healthy people а method of stimulation electroneuromyography has been developed. Examples from clinical cases are given. When examining 8 formalinized specimens peculiarities of topography of nervus thoracicus longus have been revealed.

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15

Utami, Dwi, Epon Nur’aeni i Akhmad Nugraha. "Desain Didaktis Luas Daerah Segi Empat Sembarang Berbasis Model Pembelajaran SPADE". EduBasic Journal: Jurnal Pendidikan Dasar 2, nr 1 (29.07.2020): 11–18. http://dx.doi.org/10.17509/ebj.v2i1.26427.

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This research was motivated preliminary studies results on non optimal the students’ ability of scalene rectangular area and the obstacle leraning experienced by students. The effort made by the teacher to overcome the learning obstacle is to design learning based on students’ needs and characteristics. In the implementation the teacher should adjust the design in accordance with the classroom situations and conditions. The purpose of this study were to describe the didactic design of scalene rectangular area based on the SPADE learning model for fourth grade students of elementary schools and to describe the implementation and responses of teachers and students toward the didactic design of scalene recrangular area based on the SPADE learning models in elementary schools. The research method used was a qualitative by DDR (Design Didactial Research) model consisting of three stages: prospective analysis, metapedadidactic analysis, and restropective analysis. This research was conducted in the fourth grade. The instrument of data collection used essay question on scalene rectangular area. The results of the study is a teaching materials in form of student activity sheets and lesson plans that were developed as alternatives in primary schools learning to minimize learning obstacles in mathematics learning in forth grade of elementary schools.

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16

Vaid, VinendraNath, i Aparna Shukla. "Inter scalene block: Revisiting old technique". Anesthesia: Essays and Researches 12, nr 2 (2018): 344. http://dx.doi.org/10.4103/aer.aer_231_17.

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17

Burdine, J. Michael. "Complication Rates of Scalene Regional Anesthesia". Journal of Bone and Joint Surgery-American Volume 84, nr 10 (październik 2002): 1891. http://dx.doi.org/10.2106/00004623-200210000-00028.

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18

Brown, Anthony R., i William N. Levine. "Complication Rates of Scalene Regional Anesthesia". Journal of Bone and Joint Surgery-American Volume 84, nr 10 (październik 2002): 1891–92. http://dx.doi.org/10.2106/00004623-200210000-00029.

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19

Weber, Stephen C., i Ritu Jain. "Complication Rates of Scalene Regional Anesthesia". Journal of Bone and Joint Surgery-American Volume 84, nr 10 (październik 2002): 1892–93. http://dx.doi.org/10.2106/00004623-200210000-00030.

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20

Lindig, Walter. "Erfahrungen mit der Scalene Node Biopsy". Acta Medica Scandinavica 176, S425 (24.04.2009): 246–47. http://dx.doi.org/10.1111/j.0954-6820.1964.tb05763.x.

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21

Zhang, Lei, Beverly Wang i Julie Goddard. "Challenges of Preoperative Diagnosis and Management of Scalene Intramuscular Angioma". Cancer and Clinical Oncology 5, nr 1 (18.12.2015): 20. http://dx.doi.org/10.5539/cco.v5n1p20.

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Intramuscular angioma of scalene muscle is rare with only five cases reported so far. Four of them have not been suspected before surgery; one was diagnosed preoperatively by core biopsy. Preoperative diagnosis is important for management. Awareness of cytologic features could help preoperative diagnosis when need of ruling out malignancy and coagulopathy make fine needle aspiration a choice. We herein demonstrate a new case of a 27 year old male with history of hepatocellular carcinoma, who presented with a 6 cm left supraclavicular mass. The fine needle aspiration was paucicellular; however, the bland ovoid to spindle cells with a whirling and luminal arrangement in the background of blood, fatty drops and degenerate muscle are suggestive of intramuscular angioma. The magnetic resonance imagines (MRI) demonstrate a T1 isointense and T2 hyperintense ill-defined lesion splaying anterior and mid scalene muscles with subtle vascular voids at periphery. These features in combination with cytology findings indicate intramuscular angioma. The pre-operative findings are correlated to the histologic picture of mixed capillaries and varying sized venues intervening with fatty tissue and atrophic muscle. Intraoperatively, the mass is adjacent to the brachial plexus rootlets, interdigitating with the scalene muscle and pushing the carotid sheath, left subclavicular artery and vein aside. Following embolization, the mass is resected with minimal bleeding. Our case suggests that scalene intramuscular angioma can be successfully managed by surgery after embolization; preoperative diagnosis rendered by cytologic features and imaging characters would aid the planning of surgery.

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Tubbs, R. Shane, E. George Salter, John C. Wellons, Jeffrey P. Blount i W. Jerry Oakes. "The Triangle of the Vertebral Artery". Operative Neurosurgery 56, suppl_4 (1.04.2005): ONS—252—ONS—255. http://dx.doi.org/10.1227/01.neu.0000156797.07395.15.

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Abstract OBJECTIVE: Neurosurgical procedures such as proximal brachial plexus repair, scalenotomy, and direct isolation of the proximal vertebral artery require a good working knowledge of the triangle of the vertebral artery. This deep triangle of the neck is bound by the subclavian artery and the anterior scalene and longus cervicis muscles. In addition to the vertebral artery, many important structures are found in this area, such as the ganglionated sympathetic chain and certain cervical spinal nerves. METHODS: Twenty formalin-fixed cadavers were used for this study. Dissection of this triangle was performed, and measurements were made not only of parts of its borders, but also distances from these borders to neurologically important structures within its confines, such as the C8 spinal nerve. RESULTS: In all specimens, the middle scalene muscle was noted to form part of the posterior wall of the triangle. The mean height of the triangle was found to be 3.2 cm, and the mean width of its base was 1.3 cm. We observed that the C8 spinal nerve had a mean distance of 1.2 cm inferior to the apex of the triangle and that the C7 spinal nerve was found inside the triangle in 5% of sides. If the phrenic nerve entered the triangle, it was never found more than 6 mm medial to the anterior scalene muscle. The vertebral artery always traveled intimately along the lateral border of the longus cervicis muscle, and its lateral edge ranged 5 to 8 mm medial to the medial edge of the anterior scalene muscle. CONCLUSION: The C7 spinal nerve was observed in the triangle of the vertebral artery. In addition, the posterior border of the triangle of the vertebral artery was clearly defined in this study, and the middle scalene muscle could be used as a landmark. These data, coupled with our quantitation of parts and structures within the triangle, may assist neurosurgeons who operate on this area of the neck.

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23

Grant, Nathan. "Delta Scalene: A Passage Through Mississippi Triangle". Black American Literature Forum 25, nr 2 (1991): 409. http://dx.doi.org/10.2307/3041697.

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24

Brooks, Robert, i Peter Waksman. "The first eigenvalue of a scalene triangle". Proceedings of the American Mathematical Society 100, nr 1 (1.01.1987): 175. http://dx.doi.org/10.1090/s0002-9939-1987-0883424-1.

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25

Ricci, Joseph, Kyle Eberlin i Robert Hagan. "Novel Surgical Approach for Decompression of the Scalene Triangle in Neurogenic Thoracic Outlet Syndrome". Journal of Reconstructive Microsurgery 34, nr 05 (2.02.2018): 315–20. http://dx.doi.org/10.1055/s-0037-1621728.

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Thoracic outlet syndrome (TOS) is a cause of upper extremity and shoulder dysfunction. TOS can present with a wide range of symptoms due to compression of the brachial plexus or its branches during their passage through the cervicothoracobrachial region or scalene triangle. There are three types of TOS: arterial, venous, and neurogenic. Neurogenic TOS (nTOS) is by far the most frequent type and represents more than 95% of all cases. Historically, surgical intervention for all types of TOS has evolved based on the treatment for a vascular etiology and has typically included a first rib resection. Despite nTOS being by far the more common type, most previous interventions have not considered treatment via peripheral nerve decompression.We describe surgical treatment of nTOS, performed on an outpatient basis, which focuses on the surgical decompression of the structures associated with the scalene triangle in conjunction with release of the pectoralis minor insertion through limited incisions. The procedure avoids the morbidity associated with first rib resection and is successful in ameliorating nTOS symptoms. Further, we propose a nomenclature shift to scalene triangle syndrome (STS) to reflect the nerve and arterial compressions needing to be addressed.

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Burks, Stephen Shelby, Erin M. Wolfe, Jang Won Yoon i Allan D. Levi. "Supraclavicular Resection of a Cervical Rib Causing Thoracic Outlet Syndrome: 2-Dimensional Operative Video". Operative Neurosurgery 19, nr 5 (23.05.2020): E520. http://dx.doi.org/10.1093/ons/opaa139.

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Abstract Presence of a cervical rib results from overdevelopment of the seventh cervical vertebrae.1-3 The cervical rib along with scalene muscles can cause neurogenic thoracic outlet syndrome.4,5 Rib resection is typically done via anterior approach, using either supraclavicular or transaxillary route.6,7 We present an operative video detailing supraclavicular resection of a cervical rib causing neurogenic thoracic outlet syndrome with direct decompression of the lower trunk of the brachial plexus. The patient presented with severe symptoms including hand atrophy. We were able to directly visualize the rib and resect it, along with scalene musculature. We present 3-mo follow-up data noting clinical improvement in neuropathic symptoms.

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Chaskes, Mark B., John W. Bishop, Matthew Bobinski i D. Gregory Farwell. "Myopericytoma of the Neck Originating From the Middle Scalene: A Case Report". Ear, Nose & Throat Journal 99, nr 7 (29.05.2019): NP72—NP74. http://dx.doi.org/10.1177/0145561319839821.

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We report the case of a myopericytoma of the neck. A 23-year-old female noticed a small, nontender mass in her left supraclavicular fossa. The mass grew over a period of 5 months, prompting the patient to seek evaluation. There were no motor or sensory deficits. Imaging suggested a mass originating from the middle scalene muscle. Computed tomography–guided core needle biopsy demonstrated a spindle cell neoplasm with smooth muscle differentiation. Complete surgical excision was performed. Histopathological and immunohistochemical evaluation of the tissue sample suggested myopericytoma. Myopericytoma is an extremely rare tumor of the head and neck. To our knowledge, this is the first reported case of a myopericytoma originating from a scalene muscle.

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Chaskes, Mark B., John W. Bishop, Matthew Bobinski i D. Gregory Farwell. "Myopericytoma of the Neck Originating in the Middle Scalene Muscle: A Case Report". Ear, Nose & Throat Journal 96, nr 10-11 (październik 2017): E5—E7. http://dx.doi.org/10.1177/0145561317096010-1102.

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We report a case of myopericytoma of the neck. A 23-year-old woman noticed a small, nontender mass in her left supraclavicular fossa. The mass had grown over a period of 5 months, prompting her to seek evaluation. On examination, no motor or sensory deficits were present. Imaging suggested that a mass had originated in the middle scalene muscle. Computed-tomography–guided core needle biopsy demonstrated a spindle-cell neoplasm with smooth-muscle differentiation. Complete surgical excision was performed. Histopathologic and immunohistochemical evaluations of the tissue sample suggested a myopericytoma. Myopericytoma is an extremely rare tumor of the head and neck. To the best of our knowledge, this is the first reported case of a myopericytoma originating in a scalene muscle.

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Sanders, Richard J., Catherie G. Ratzin Jackson, Natalio Banchero i William H. Pearce. "Scalene muscle abnormalities in traumatic thoracic outlet syndrome". American Journal of Surgery 159, nr 2 (luty 1990): 231–36. http://dx.doi.org/10.1016/s0002-9610(05)80269-7.

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Joshy, S., G. Menon i A. Iossifidis. "Inter-scalene block in day-case shoulder surgery". European Journal of Orthopaedic Surgery & Traumatology 16, nr 4 (19.07.2006): 327–29. http://dx.doi.org/10.1007/s00590-006-0101-4.

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Petru, Edgar, Hellmuth Pickel, Karl Tamussino, Manfred Lahousen, Michaela Heydarfadai, Wilhelm Posawetz i Robert Jakse. "Pretherapeutic scalene lymph node biopsy in ovarian cancer". Gynecologic Oncology 43, nr 3 (grudzień 1991): 262–64. http://dx.doi.org/10.1016/0090-8258(91)90032-z.

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Padaki, Amit S., R. Warne Fitch, Lawrence B. Stack i R. Jason Thurman. "Horner's Syndrome after Scalene Block and Carotid Dissection". Journal of Emergency Medicine 50, nr 5 (maj 2016): e215-e218. http://dx.doi.org/10.1016/j.jemermed.2016.01.027.

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Ozawa, Hiroyuki, Masato Fujii, Toshiki Tomita i Kaoru Ogawa. "Intramuscular myxoma of scalene muscle: a case report". Auris Nasus Larynx 31, nr 3 (wrzesień 2004): 319–22. http://dx.doi.org/10.1016/j.anl.2004.03.009.

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Goubran, Emile, Jonathan Carlos i Samir Ayad. "A bifurcated anterior scalene muscle: A case report". Clinical Chiropractic 13, nr 2 (czerwiec 2010): 153–55. http://dx.doi.org/10.1016/j.clch.2010.02.020.

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Sukhani, Radha, Joanna Barclay i Mark Aasen. "Prolonged Horner??s Syndrome After Inter scalene Block". Anesthesia & Analgesia 79, nr 3 (wrzesień 1994): 601???603. http://dx.doi.org/10.1213/00000539-199409000-00038.

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Rassat, André, i Patrick W Fowler. "Any Scalene Triangle Is the Most Chiral Triangle". Helvetica Chimica Acta 86, nr 5 (maj 2003): 1728–40. http://dx.doi.org/10.1002/hlca.200390143.

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Arias-Buría, José L., Álvaro Monroy-Acevedo, César Fernández-de-las-Peñas, Gracia M. Gallego-Sendarrubias, Ricardo Ortega-Santiago i Gustavo Plaza-Manzano. "Effects of dry needling of active trigger points in the scalene muscles in individuals with mechanical neck pain: a randomized clinical trial". Acupuncture in Medicine 38, nr 6 (30.03.2020): 380–87. http://dx.doi.org/10.1177/0964528420912254.

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Objective: The aim of this study was to compare the effects of dry needling (DN) versus pressure release over scalene muscle trigger points (TrPs) on pain, related disability, and inspiratory vital capacity in individuals with neck pain. Methods: In this randomized, single-blind trial, 30 patients with mechanical neck pain and active TrPs in the scalene musculature were randomly allocated to trigger point dry needling (TrP-DN; n = 15) or pressure release (n = 15) groups. The DN group received a single session of DN of active TrPs in the anterior scalene muscles, and the pressure release group received a single session of TrP pressure release over the same muscle lasting 30 s. The primary outcome was pain intensity as assessed by a numerical pain rate scale (NPRS, 0–10). Secondary outcomes included disability (neck disability index, NDI) and inspiratory vital capacity. Outcomes were assessed at baseline and 1 day (immediately post), 1 week, and 1 month after the treatment session. Data were expressed as mean score difference (Δ) and standardized mean difference (SMD). Results: Patients receiving DN exhibited a greater decrease in pain intensity than those receiving TrP pressure release at 1 month (Δ 1.2 (95% CI–1.8, –0.6), p = 0.01), but not immediately (1 day) or 1 week after. Patients in the DN group exhibited a greater increase in inspiratory vital capacity at all follow-up time points (Δ 281 mm (95% CI 130, 432) immediately after, Δ 358 mm (95% CI 227, 489) 1 week after, and Δ 310 mm (95% CI 180, 440) 1 month after treatment) than those in the pressure release group (p = 0.006). Between-group effect sizes were large at all follow-up time points (1.1 > SMD > 1.3) in favor of DN. Conclusion: This trial suggests that a single session of DN over active TrPs in the scalene muscles could be effective at reducing pain and increasing inspiratory vital capacity in individuals with mechanical neck pain. Future studies are needed to further confirm these results.

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Rached, Roberto, WuT Hsing i Chennyfer Rached. "Evaluation of the efficacy of ropivacaine injection in the anterior and middle scalene muscles guided by ultrasonography in the treatment of Thoracic Outlet Syndrome". Revista da Associação Médica Brasileira 65, nr 7 (lipiec 2019): 982–87. http://dx.doi.org/10.1590/1806-9282.65.7.982.

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SUMMARY A clinical, placebo-controlled, randomized, double-blind trial with two parallel groups. OBJECTIVE to evaluate the efficacy of ropivacaine injection in each belly of the anterior and middle scalene muscles, guided by ultrasonography, in the treatment of Nonspecific Thoracic Outlet Syndrome (TOS) compared to cutaneous pressure. METHODS 38 patients, 19 in the control group (skin pressure in each belly of the anterior and middle scalene muscles) and 19 in the intervention group (ropivacaine). Subjects with a diagnosis of Nonspecific Thoracic Outlet Syndrome, pain in upper limbs and/or neck, with no radiculopathy or neurological involvement of the limb affected due to compressive or encephalic root causes were included. The primary endpoint was functionality, evaluated by the Disabilities of the Arm, Shoulder, and Hand - DASH scale validated for use in Brasil. The time of the evaluations were T0 = before the intervention; T1 = immediately after; T2 = 1 week; T3 = 4 weeks; T4 = 12 weeks; for T1, the DASH scale was not applied. RESULTS Concerning the DASH scale, it is possible to affirm with statistical significance (p> 0.05) that the intervention group presented an improvement of functionality at four weeks, which was maintained by the 12th week. CONCLUSION In practical terms, we concluded that a 0.375% injection of ropivacaine at doses of 2.5 ml in each belly of the anterior and middle scalene muscles, guided by ultrasonography, in the treatment of Nonspecific Thoracic Outlet Syndrome helps to improve function.

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Wang, Ziqi, Thomas Lotina i John Malaty. "Uncommon presentation and complications of herpes zoster infection involving the cervical, vagus and accessory nerves which caused a delay in diagnosis and treatment". BMJ Case Reports 14, nr 5 (maj 2021): e241881. http://dx.doi.org/10.1136/bcr-2021-241881.

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A 70-year-old man with a history of invasive anal squamous cell carcinoma treated with excision and chemoradiation presented to the emergency department with right-sided neck pain and submandibular lymphadenopathy. CT imaging of the head and neck was unrevealing. The patient eventually developed cranial nerves X and XI dysfunction, manifesting as severe vocal cord paralysis (dysphonia), dysphagia, asymmetric palate elevation/deviation and trapezius muscle atrophy, in addition to scalene muscle atrophy. After an extensive workup, the patient’s symptoms were determined to be due to sequelae of varicella zoster infection, which was confirmed with antibody titers. The patient’s dysphagia and dysphonia eventually improved with vocal cord medialisation injection and Botox injection. However, despite delayed treatment with acyclovir and valacyclovir, the patient continued to have neuropathic pain and exhibit signs of CN X and CN XI paresis, in addition to scalene muscle atrophy.

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Mahata, Kingsuk, i Michael Schmittel. "Impact of the level of complexity in self-sorting: Fabrication of a supramolecular scalene triangle". Beilstein Journal of Organic Chemistry 7 (22.11.2011): 1555–61. http://dx.doi.org/10.3762/bjoc.7.183.

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The impact of the level of complexity in self-sorting was elaborated through the fabrication of various scalene triangles. It turned out that the self-sorting system with a higher level of complexity was far superior to less complex sorting algorithms.

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ATASOY, E. "Thoracic Outlet Compression Syndrome Caused by a Schwannoma of the C7 Nerve Root". Journal of Hand Surgery 22, nr 5 (październik 1997): 662–63. http://dx.doi.org/10.1016/s0266-7681(97)80370-1.

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This is the first report of a schwannoma originating from the C7 nerve root causing thoracic outlet compression syndrome. The patient was a 30-year-old woman with a 3-year history of numbness on the radial side of the left hand, left arm tiredness, nocturnal pain in the left forearm and pain in the left elbow, shoulder and neck. Conservative treatment and previous operations, including carpal tunnel release and first rib resection, provided no relief. A left scalenectomy was performed. During the removal of the anterior scalene muscle, a mass approximately 3 cm long and 1.5 cm in diameter was noted under the anterior scalene muscle involving the C7 nerve root. The tumour was encapsulated and covered with attenuated and stretched nerve fascicles. It was completely excised without disturbing the nerve fascicles. The clinical impression was schwannoma, which was confirmed on pathological examination.

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Silva, A., H. Gama, S. Siqueira, M. Sales, A. Franco i M. Casagrande. "Seventh cervical nerve perforating the middle scalene muscle: a possible clinical and surgical application". Journal of Morphological Sciences 31, nr 01 (styczeń 2014): 006–8. http://dx.doi.org/10.4322/jms.ao041013.

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Abstract Introduction: In most of cases, the emergency of the nervous roots of the brachial plexus in the posterior cervical triangle occur between the anterior and middle scalene muscles. However, anatomic variations in the brachial plexus are not rare. Methods: In the laboratory of Human Anatomy of the “Faculdade de Ciências Médicas de Minas Gerais” 106 cadavers were dissected. There were dissected the cervical region of all of the cadavers bilaterally. Results: In routinely dissection in the laboratory of human anatomy of the “Faculdade de Ciencias Médicas de Minas Gerais” we've found in the left cervical region of a male cadaver the ventral branch ofthe seventh cervical nerve (C7) perforating the substance ofthe middle scalene muscle. Conclusion: Professionals that work with this region on the practice must pay attention to this and other variations in the constitution of the brachial plexus in the clinic and surgical procedures to avoid complications.

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Mittal, Nikita, Manik Lal Saha i Michael Schmittel. "A seven-component metallosupramolecular quadrilateral with four different orthogonal complexation vertices". Chemical Communications 51, nr 85 (2015): 15514–17. http://dx.doi.org/10.1039/c5cc06324h.

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The 4-fold completive self-sorting of a ten-component library (7 dissimilar donors and 3 different acceptors) resulted in the clean self-assembly of four dynamic orthogonal complexes that were used as cornerstones in two novel six- and seven-component scalene quadrilaterals.

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Eckert, Danny J., R. Doug McEvoy, Kate E. George, Kieron J. Thomson i Peter G. Catcheside. "Effects of hypoxia on genioglossus and scalene reflex responses to brief pulses of negative upper-airway pressure during wakefulness and sleep in healthy men". Journal of Applied Physiology 104, nr 5 (maj 2008): 1426–35. http://dx.doi.org/10.1152/japplphysiol.01056.2007.

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Hypoxia can depress ventilation, respiratory load sensation, and the cough reflex, and potentially other protective respiratory reflexes such as respiratory muscle responses to increased respiratory load. In sleep-disordered breathing, increased respiratory load and hypoxia frequently coexist. This study aimed to examine the effects of hypoxia on the reflex responses of 1) the genioglossus (the largest upper airway dilator muscle) and 2) the scalene muscle (an obligatory inspiratory muscle) to negative-pressure pulse stimuli during wakefulness and sleep. We hypothesized that hypoxia would impair these reflex responses. Fourteen healthy men, 19–42 yr old, were studied on two separate occasions, ∼1 wk apart. Bipolar fine-wire electrodes were inserted orally into the genioglossus muscle, and surface electrodes were placed overlying the left scalene muscle to record EMG activity. In random order, participants were exposed to mild overnight hypoxia (arterial oxygen saturation ∼85%) or medical air. Respiratory muscle reflex responses were elicited via negative-pressure pulse stimuli (approximately −10 cmH2O at the mask, 250-ms duration) delivered in early inspiration during wakefulness and sleep. Negative-pressure pulse stimuli resulted in a short-latency activation followed by a suppression of the genioglossus EMG that did not alter with hypoxia. Conversely, the predominant response of the scalene EMG to negative-pressure pulse stimuli was suppression followed by activation with more pronounced suppression during hypoxia compared with normoxia (mean ± SE suppression duration 64 ± 6 vs. 38 ± 6 ms, P = 0.006). These results indicate differential sensitivity to the depressive effects of hypoxia in the reflex responsiveness to sudden respiratory loads to breathing between these two respiratory muscles.

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Duiverman, Marieke L., Leo A. van Eykern, Peter W. Vennik, Gerard H. Koëter, Eric J. W. Maarsingh i Peter J. Wijkstra. "Reproducibility and responsiveness of a noninvasive EMG technique of the respiratory muscles in COPD patients and in healthy subjects". Journal of Applied Physiology 96, nr 5 (maj 2004): 1723–29. http://dx.doi.org/10.1152/japplphysiol.00914.2003.

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In the present study, we assessed the reproducibility and responsiveness of transcutaneous electromyography (EMG) of the respiratory muscles in patients with chronic obstructive pulmonary disease (COPD) and healthy subjects during breathing against an inspiratory load. In seven healthy subjects and seven COPD patients, EMG signals of the frontal and dorsal diaphragm, intercostal muscles, abdominal muscles, and scalene muscles were derived on 2 different days, both during breathing at rest and during breathing through an inspiratory threshold device of 7, 14, and 21 cmH2O. For analysis, we used the logarithm of the ratio of the inspiratory activity during the subsequent loads and the activity at baseline [log EMG activity ratio (EMGAR)]. Reproducibility of the EMG was assessed by comparing the log EMGAR values measured at test days 1 and 2 in both groups. Responsiveness (sensitivity to change) of the EMG was assessed by comparing the log EMGAR values of the COPD patients to those of the healthy subjects at each load. During days 1 and 2, log EMGAR values of the diaphragm and the intercostal muscles correlated significantly. For the scalene muscles, significant correlations were found for the COPD patients. Although inspiratory muscle activity increased significantly during the subsequent loads in all participants, the COPD patients displayed a significantly greater increase in intercostal and left scalene muscle activity compared with the healthy subjects. In conclusion, the present study showed that the EMG technique is a reproducible and sensitive technique to assess breathing patterns in COPD patients and healthy subjects.

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Ortega-Santiago, Ricardo, Maite Maestre-Lerga, César Fernández-de-las-Peñas, Joshua A. Cleland i Gustavo Plaza-Manzano. "Widespread Pressure Pain Sensitivity and Referred Pain from Trigger Points in Patients with Upper Thoracic Spine Pain". Pain Medicine 20, nr 7 (1.03.2019): 1379–86. http://dx.doi.org/10.1093/pm/pnz020.

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Abstract Objectives The presence of trigger points (MTrPs) and pressure pain sensitivity has been well documented in subjects with neck and back pain; however, it has yet to be examined in people with upper thoracic spine pain. The purpose of this study was to investigate the presence of MTrPs and mechanical pain sensitivity in individuals with upper thoracic spine pain. Methods Seventeen subjects with upper thoracic spine pain and 17 pain-free controls without spine pain participated. MTrPs were examined bilaterally in the upper trapezius, rhomboid, iliocostalis thoracic, levator scapulae, infraspinatus, and anterior and middle scalene muscles. Pressure pain thresholds (PPTs) were assessed over T2, the C5-C6 zygapophyseal joint, the second metacarpal, and the tibialis anterior. Results The numbers of MTrPs between both groups were significantly different (P < 0.001) between patients and controls. The number of MTrPs for each patient with upper thoracic spine pain was 12.4 ± 2.8 (5.7 ± 4.0 active TrPs, 6.7 ± 3.4 latent TrPs). The distribution of MTrPs was significantly different between groups, and active MTrPs within the rhomboid (75%), anterior scalene (65%), and middle scalene (47%) were the most prevalent in patients with upper thoracic spine pain. A higher number of active MTrPs was associated with greater pain intensity and longer duration of pain history. Conclusions This study identified active MTrPs and widespread pain hypersensitivity in subjects with upper thoracic spine pain compared with asymptomatic people. Identifying proper treatment strategies might be able to reduce pain and improve function in individuals with upper thoracic spine pain. However, future studies are needed to examine this.

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Miyamoto, Hideaki, Toshiaki Masaoka, Yûtsuke Mitoma, Kazushi Hayakawa i Enjô Hata. "Indications for and usefulness of scalene node biopsy today." Journal of the Japanese Association for Chest Surgery 5, nr 7 (1991): 712–16. http://dx.doi.org/10.2995/jacsurg1987.5.712.

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Lee, Gun Woo, Young Ho Kwon, Ju Ho Jeong i Jung Won Kim. "The Efficacy of Scalene Injection in Thoracic Outlet Syndrome". Journal of Korean Neurosurgical Society 50, nr 1 (2011): 36. http://dx.doi.org/10.3340/jkns.2011.50.1.36.

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KESSLER, J., i A. GRAY. "Sonography of Scalene Muscle Anomalies for Brachial Plexus Block". Regional Anesthesia and Pain Medicine 32, nr 2 (marzec 2007): 172–73. http://dx.doi.org/10.1016/j.rapm.2006.09.011.

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Scott, J. A. "103.11 On the Spieker centre of a scalene triangle". Mathematical Gazette 103, nr 556 (14.02.2019): 153–54. http://dx.doi.org/10.1017/mag.2019.26.

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