Inter scalene block was performed by palpating groove between the anterior scalene and middle scalene muscle
[4,5,6] with 23 x 1.5G needle and locating neurovascular bundle by moving the needle anteriorly and posteriorly.
"In that space you have the large scalene muscle
of the neck, nerves and arteries--they all get compressed and squashed.
Neither approach eliminates risk of nerve injury as the dorsal scapular nerve (DSN) and the long thoracic nerve (LTN) travel through the middle scalene muscle
, while the phrenic nerve may be placed at risk of injury while traversing along the anterior scalene muscle
The initial ultrasound examination aided in localizing the mass external to the scalene muscle
, leading us away from this diagnosis.
The main etiology described for DSN entrapment is hypertrophy of the middle scalene muscle
causing compression of the nerve as it passes through.21 Mondelli et al.
Keywords: Intramuscular hemangioma, scalene muscle
Extension into the spinal canal on the left was noted from C6/7 to the bottom of the T1 level without cord compression, along with abnormal bone marrow signal intensity involving the posteromedial first rib and left anterior scalene muscle
, all again consistent with leukemic infiltration.
Anatomic predispositions (cervical ribs, abnormal first ribs, alterations of the costoclavicular ligaments, anomalies of the scalene muscle
, or insertion of the pectoralis minor) and extrinsic factors like trauma or chronic repetitive movements may result in TOS [6, 7].
Upon exiting their respective neural foramina, the roots travel in the interscalene space, bounded anteriorly by the anterior scalene muscle
, posteriorly by the middle/posterior scalene muscles
, and inferiorly by the subclavian artery/first rib.
Operative treatment for PSS includes first rib resection, scalene muscle
removal, or subclavius muscle removal, along with removal of constricting scar tissue from around the vein.
Soft-tissue abnormalities include scalene muscle
abnormalities and fibrous bands.
The lesion is situated posterolateral to right sternocleidomastoid muscle, lateral to right carotid and jugular vessel and right scalene muscle
anterior to right trapezius muscle and posterosuperior to clavicle and subclavian vessel suggestive of possible lymphangioma.