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Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study

 Yong Wook Kim  ;  Seo Yeon Yoon  ;  Yongbum Park  ;  Won Hyuk Chang  ;  Sang Chul Lee 
 YONSEI MEDICAL JOURNAL, Vol.57(2) : 490-495, 2016 
Journal Title
Issue Date
Adult ; Brachial Plexus/drug effects* ; Cross-Over Studies ; Exercise Therapy* ; Female ; Humans ; Injections, Intramuscular* ; Male ; Middle Aged ; Neck Muscles/drug effects ; Pain/drug therapy ; Pain Measurement ; Paresthesia/drug therapy* ; Paresthesia/rehabilitation ; Single-Blind Method ; Thoracic Outlet Syndrome/diagnosis ; Thoracic Outlet Syndrome/drug therapy* ; Treatment Outcome
Thoracic outlet syndrome ; injection ; scalene muscle ; ultrasound
PURPOSE: To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only.
MATERIALS AND METHODS: Twenty patients with upper extremity paresthesia who met the criteria were recruited to participate in this single-blind, crossover study. Fourteen of 20 patients were female. The average age was 45.0 ± 10.5 years and duration of symptom was 12.2 ± 8.7 months. Each participant completed one injection and daily exercise program for 2 weeks. After randomization, half of all patients received ultrasound-guided injection of scalene muscles before exercise, while the other was invested for the other patients.
RESULTS: After two weeks, there was a significant decrease of the visual analog scale score of treatment effect compared with baseline in both groups (6.90 to 2.85 after injection and 5.65 to 4.05 after stretching exercise, p<0.01). However, injection resulted in greater improvements than stretching exercise (p<0.01). The number of patients with successful treatment, defined as >50% reduction in post-treatment visual analog scale, was 18 of 20 (90.0%) after injection, compared to 5 of 20 (25.0%) after stretching exercise. There were no cases of unintended brachial plexus block after injection.
CONCLUSION: Ultrasound-guided steroid injection or stretching exercise of scalene muscles led to reduced upper extremity paresthesia in patients who present with localized tenderness in the scalene muscle without electrodiagnostic test abnormalities, although injection treatment resulted in more improvements. The results suggest that symptoms relief might result from injection into the muscle alone not related to blockade of the brachial plexus.
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1. College of Medicine (의과대학) > Dept. of Rehabilitation Medicine (재활의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Wook(김용욱) ORCID logo https://orcid.org/0000-0002-5234-2454
Yoon, Seo Yeon(윤서연)
Lee, Sang Chul(이상철) ORCID logo https://orcid.org/0000-0002-6241-7392
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