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Clinical Efficacy of Scalene Injection for Thoracic Outlet Syndrome
Samuel Baek, MD, MS1, Myung Ho Shin, MD2, Tae Min Kim, MD, MS3, Seoung Joon Lee, MD, PhD4, Dongkeun Jun, MD, MS5, Sung Jin An, MD6, Geum-Ho Lee, MD1, Seok Kim, MD1, Suk-Hyun Hwang, MD, MS1 and Young-Ho Kwon, MD, PhD7, (1)Seoul Red Cross Hospital, Seoul, Korea, Republic of (South), (2)CM Hospital, Seoul, Korea, Republic of (South), (3)Yonseigunwoo Hospital, Seoul, Korea, Republic of (South), (4)Konkuk University, School of Medicine, Seoul, Korea, Republic of (South), (5)Konkuk University Medical Center, Seoul, Korea, Republic of (South), (6)Busan Bumin Hospital, Busan, Korea, Republic of (South), (7)Kosin University College of Medicine, Busan, Korea, Republic of (South)

Purpose: We introduce the novel treatment technique, scalene injection, and study its clinical efficacy for diagnosis, treatment and pain control for patients with thoracic outlet syndrome.
Methods: 266 patients who were treated with scalene injection between November 2001 and October 2018, were studied retrospectively. To evaluate the efficacy and sustainability of scalene injection, we checked the numerical rating scale (NRS) for pain relief and neck disability index (NDI) for functional improvements, prior and 12 weeks after the injection. The safety of injection was evaluated by examining side effects for at least 24 hours from the point of injection.
Results: NRS was improved from 7.12 to 3.05 and NDI was improved from 15.87 to 6.19 (p<0.05). There were 2 cases of convulsion immediately after the injection, and were treated with prompt oxygen supply and sedatives. Transient side effects included 2 cases of dyspnea and 1 case of nausea, and were resolved within 1 hour after the injection. All 5 cases showed symptoms of side effects on the day of injection and were resolved within a day. 242 patients (90.9%) experienced immediate improvements in pain and 161 patients experienced persistent effect of the pain relief for more than 12 weeks. However, 24 patients (9.0%) showed no improvement in pain and 20 patients (7.5%) experienced recurrence or worsening of pain.
Conclusion: For thoracic outlet syndrome, scalene injection is effective not only as a diagnostic tool but also as a therapeutic strategy. However, this study suggests that scalene injection must be done with monitoring of vital signs in an operating room for any possible complications and side effects.


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