Patient 3 is a 28-year-old software engineer who developed intermittent numbness in his left hand over a one-year period, while using the computer mouse with his left hand. The patient then moved to a new and more demanding work environment with poorly designed ergonomics, and his left hand numbness became constant within weeks. Shortly thereafter, the patient developed constant pain in his left hand, and was unable to wear a watch on his left wrist.
After switching to right-handed mouse use, the patient developed pain and numbness in his right hand. He also noted decreased temperature in right greater than left hands, and sensitivity to cold objects in each. All symptoms were exacerbated by computer use.
The patient stopped regular work on a computer, but over the following three months he experienced the progression of previous symptoms, and developed bilateral wrist, forearm, and neck pain. All symptoms were aggravated immediately upon any use of his hands. After completely ceasing computer work for a period of six months, the patient's symptoms improved considerably.
MRI scanning demonstrates hypertrophy of both anterior scalene muscles and middle scalene muscles, with marked narrowing of each scalene triangle apex and effacement of fat around each brachial plexus (Figure 1). Several right-sided scalene muscle anomalies further narrow the right scalene triangle plexus (Figure 2). An anomalous right anterior scalene muscle inserts both anteriorly and posteriorly to the subclavian artery, and with an anomalous fibrous band, contributes to further narrowing of the right scalene triangle (Figure 3).
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