title: Comparison between Steroid Injection and Stretching Exercise on the Scalene of Patients with Upper Extremity Paresthesia: Randomized Cross-Over Study.
abstract: OBJECTIVE
  To compare the therapeutic effects on upper extremity paresthesia of intra-muscular steroid injections into the scalene muscle with those of stretching exercise only.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Yong Wook
authors: YW
authors: Kim
authors: Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Seo Yeon
authors: SY
authors: Yoon
authors: Department of Physical Medicine & Rehabilitation, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors: Yongbum
authors: Y
authors: Park
authors: Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: Won Hyuk
authors: WH
authors: Chang
authors: Department of Rehabilitation Medicine and Research Institute, Yonsei University College of Medicine, Seoul, Korea. bettertomo@yuhs.ac.
authors: Sang Chul
authors: SC
authors: Lee
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000187:drug effects*; D018592:Cross-Over Studies; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000187:drug effects; D010146:Pain / Q000188:drug therapy; D010147:Pain Measurement; D010292:Paresthesia / Q000188:drug therapy* / Q000534:rehabilitation; D016037:Single-Blind Method; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome
keywords: Thoracic outlet syndrome; injection; scalene muscle; ultrasound