Scapular back nerve entrapment syndrome

　　1. Etiology

　　It is caused by the compression of the scapular back nerve or C5 nerve root due to anatomical factors during their course.

　　2. Pathogenesis

　　The possible causes of scapular back nerve entrapment may be two aspects: one is the compression of the cervical nerve root, especially the C5 nerve root, which involves the scapular back nerve as its branch; the other reason is that the scapular back nerve is compressed due to anatomical factors during its course, such as passing through the tendinous origin fibers of the middle scalene muscle. Therefore, most of the scapular back nerve entrapment exists in the thoracic outlet syndrome, but it can also exist alone.

　　At present, no complications of the disease have been found. The patient's diet should be light and easy to digest, eat more vegetables and fruits, reasonably match the diet, and pay attention to sufficient nutrition. In addition, patients should also pay attention to avoiding spicy, greasy, and cold foods.

　　1. Common symptoms:This disease is common in middle-aged and young women, and all patients mainly present with discomfort, pain in the neck, shoulder, and back. Neck discomfort is related to the weather, worsening in rainy days and winter, and can also worsen after fatigue. There is a pulling sensation in the neck when the upper arm is extended or raised. The pain in the neck, shoulder, and back often makes the patient unable to sleep, feeling uncomfortable with the affected limb, but unable to clearly point out the site of pain.

　　2. Less common symptoms:In a few cases, there may be shoulder weakness, occasional numbness in the hand, mainly in the numbness of the anterior forearm and the radial side of the hand.

　　This disease is caused directly by trauma, such as falls, accidents, or sudden braking when driving. Therefore, attention should be paid to living habits, and high-risk workers such as construction workers, miners, and drivers are prone to injury, and protection should be paid in the process of work. Stay calm when dealing with things to avoid emotional excitement and conflict leading to this disease. Secondly, early discovery, early diagnosis, and early treatment are also of great significance for the prevention of this disease.

　　1. Electromyogram examination:The supraspinatus, infraspinatus, deltoid, and rhomboid muscles showed no abnormalities. In 7 cases, there were fibrillation potentials in the first dorsal interosseous muscle and the abductor digiti minimi, and the rhomboid muscle may not have been detected due to its deep location. No abnormalities were found in the nerve conduction velocity.

　　2. Cervical X-ray:22 cases showed no abnormalities, 8 cases had an elongated transverse process of the 7th cervical vertebra, and 4 cases had degenerative changes in the cervical spine.

　　What kind of food is good for the scapular dorsal nerve entrapment syndrome patient's body:

　　Pay attention to a light diet, eat more vegetables and fruits, and rationally match the diet. The diet of patients should be light, easy to digest, eat more vegetables and fruits, and pay attention to sufficient nutrition. In addition, patients also need to pay attention to avoiding spicy, greasy, and cold foods.

　　First, treatment

　　1. Conservative treatment:First consider conservative treatment, mainly focusing on local closure. The points of closure are two trigger points, one is the posterior margin of the midpoint of the sternocleidomastoid muscle, and the other is 3cm beside the spinous process of the 3rd and 4th thoracic vertebrae. The author suggests 1 time a week, for 3 to 6 times consecutively.辅以理疗，半数患者症状可显著减轻。18例做3～6次颈部压痛点封闭治疗，6例症状显著减轻；4例改善，酸痛可以忍受；9例无效，其中7例确诊后行手术治疗。

　　2. Surgical treatment:For patients with ineffective conservative treatment or severe symptoms of thoracic outlet syndrome, surgical treatment can be considered. A transverse incision or 'L' shaped incision is made at the base of the neck under general anesthesia, and the transverse cervical artery and the sternocleidomastoid muscle are ligated. The roots of the brachial plexus nerves and the lower segments of the anterior and middle scalene muscles are exposed layer by layer. At the proximal end, the anterior and middle scalene muscles are cut, and the fibrous tissue surrounding the root of the C5 nerve is cut along the C5 nerve. Further, the middle scalene muscle is transversely cut at the base of the C5 nerve, exposing the scapular dorsal nerve, cutting the surrounding tissue of the nerve, and performing a neurolemmectomy. 5ml of triamcinolone acetonide is locally injected before the incision is closed. After surgery, prednisone 5mg can be used, 3 times a day, for a total of 7 days.

　　3. Intraoperative observation:The scapular dorsal nerve runs 1 to 3 cm within the scalene muscle, and the origin of the scapular dorsal nerve can be clearly identified. The scapular dorsal nerve is all tendinous or tendomuscular tissue at the level of the middle scalene muscle. The author has performed surgical treatment for 25 sides in 23 patients, of which 2 sides of 3 sides of the scapular dorsal nerve are covered with a few fibrous tissues of the middle scalene muscle except for the origin, and the rest run on the surface of the middle scalene muscle; 2 sides of 3 sides run 1 to 2 cm within the middle scalene muscle; 18 sides of 19 sides run diagonally within the middle scalene muscle for 2 to 3 cm; among which 17 sides can clearly identify the origin of the scapular dorsal nerve, 3 sides are independent origins, 14 sides merge with the C5 long thoracic nerve, and the length of the trunk is within 1 cm in 4 sides, 1 to 4 cm in 10 sides; 22 sides of 24 sides are tendinous or tendomuscular tissue at the level of the middle scalene muscle. The subclavian artery position of this group of patients is higher, 18 cases are higher than the superior border of the clavicle, and can reach 4 to 5 cm above the superior border of the clavicle, the highest case reaching 6 cm, with an average of 3.5 cm.

　　Two, Prognosis

　　1. Conservative treatment has a good short-term effect, but it is prone to recurrence. The recurrence rate is still 50% after 3 to 6 times of local block treatment. Local block treatment can be carried out again after an interval of 2 to 3 months.

　　1. Conservative treatment has a good short-term effect, but it is prone to recurrence. The recurrence rate is still 50% after 3 to 6 times of local block treatment. Local block treatment can be carried out again after an interval of 2 to 3 months. 2. 22 patients had complete or most of their neck, shoulder, and back symptoms disappear after surgery. Three days after surgery, patients may feel discomfort similar to before surgery, but the symptoms gradually subsided one week after surgery, and most or all symptoms disappeared three weeks after surgery. Follow-up time ranged from 3 months to 2 years, and symptoms and signs recurred in 4 sides of 3 patients two months after surgery, with the same degree as before surgery. Among them, 2 sides of 1 patient with bilateral thoracic outlet syndrome who did not undergo decompression of the origin of the scapular dorsal nerve showed recurrence of symptoms on the third day after surgery and gradually worsened, and were not cured more than a year later. The other 2 sides were due to local scar compression after surgery, and symptoms were currently controllable after local blockade. The symptoms of 16 patients with decreased sensation in the medial forearm and little finger were significantly improved after surgery, and there were fluctuations three days after surgery, which gradually returned to normal 2 to 3 weeks later.