Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Monday, March 29, 2010


The Russian article (see abstract below) discusses the entrapment of the neuromuscular bundle in fibruous bands in the scalene muscles. These muscles are very important in sleep apnea patients. They are normally accessory breathing muscles but are overused when patients with obstructive apnea try to breathe past an obstruction. Long term overuse can lead to taut bands and trigger points as described by Dr Janet Travell. These trigger points can lead to upper quarter pain including the entire arm and hand as well as anterior and posterior shouler regions.

In addition the nerve roots of the brachial plexus can be compressed between the anterior and medial scalene muscles. The authors call this scalenus anticus syndrome a subtype of thoracic outlet syndrome. These problems can be adressed by body work such as massage or myotherapy but correcting the underlying sleep apnea will often result in self correction of this problem. This will result in many patients utilizing CPAP or oral appliances.

In patients where the condition does not self correct a neuromuscular orthotic may give amazing relief. See http://www.ihateheadaches.org

Georgian Med News. 2005 Sep;(126):18-23.

[Fibrous-muscular and vessels anomalies revealing during surgery of the scalenus anticus syndrome]

[Article in Russian]

Tsitsuashvili G, Dzhavakhishvili G, Buddzhiashvili V, Gogeliani A, Rcheulishvili I.

National Center of Surgery, Tbilisi, Georgia.

One hundred and twenty five operations on 100 patients were performed due to the symptoms suggesting presence of the pressure on the neurovascular supraclavicular structures, although X-ray showed no evidence of cervical rib. In 15 cases of patients with so-called scalenus anticus syndrome as one of the forms of thoracic outlet syndrome (TOS) seemed to be compressing the neurovascular bundle. Scalenus mediums muscle appeared to be producing more compression of the nerve roots than did the scalenus anterior in 5 patients. Pressure from Rudimentary First Rib--in 2 cases in our series malformation of the first rib was the cause of the patient's distress. Anomalous Bands--in 4 cases anomalous bands of fibrous tissue in the supraclavicular area were the cause of compression of the neurovascular bundle Anomaleus Arteries Compressing Nerve Roots- large arteries compressed roots of trunks of the brachial plexus in four patients in our series to such an extent that it seemed these structures were the cause of the patient's symptoms. All anomalous structures were removed, good results after such surgical tactics were kept for long time in all cases. Therefore the surgeons, performing scalenotomy have to pay particular attention to the fibrous bands and anomalies in the scalene group of muscles.

PMID: 16234586 [PubMed - indexed for MEDLINE]

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posted by ilshapira at 5:01 AM