From the Research
A scalenectomy is a surgical procedure that involves the removal or resection of one or more scalene muscles in the neck, typically performed to treat thoracic outlet syndrome (TOS), and is considered when conservative treatments have failed to provide adequate relief. This procedure is designed to decompress the affected area and relieve symptoms such as pain, numbness, tingling, or weakness in the arm, hand, or fingers that occur when the scalene muscles compress nearby structures 1. The scalene muscles extend from the cervical vertebrae to the first and second ribs and play a role in neck movement and breathing.
Key Points About Scalenectomy
- The procedure involves removing the problematic scalene muscle(s), usually the anterior and/or middle scalene, to decompress the affected area and relieve symptoms.
- Recovery from a scalenectomy typically takes several weeks, with physical therapy often recommended afterward to restore normal function.
- The decision to perform a scalenectomy is generally made when conservative treatments like physical therapy and medication have failed to provide adequate relief, as supported by studies such as 2, which highlights the efficacy of surgical intervention for post-traumatic neurogenic thoracic outlet syndrome.
- Recent studies, such as 1, have explored the impact of scalene muscle botulinum toxin injection with and without surgery in neurogenic thoracic outlet syndrome, providing insights into the utility of these approaches in managing symptoms.
Considerations and Evidence
The evidence from studies such as 3, 4, and 5 provides a foundation for understanding the role of scalenectomy in treating thoracic outlet syndrome. However, the most recent and highest quality study, 1, offers the most relevant guidance on the current approach to scalenectomy, emphasizing its effectiveness in conjunction with other treatments for neurogenic thoracic outlet syndrome. Therefore, the recommendation for a scalenectomy should be based on the latest evidence, prioritizing the patient's morbidity, mortality, and quality of life outcomes.