Many people have seen images of a person being treated with a number of tiny needles in their skin. Traditional acupuncture practitioners believe that the chi (pronounced ‘chee’) in the body must be balanced. Neuroscientists suggest that the needles stimulate nerves or blood vessels, or perhaps stimulate release of the body’s natural pain relievers. Acupuncture has been deemed effective by organizations such as the World Health Organization (WHO) and the National Center for Complementary and Integrative Health (NCCIH) in the treatment of a number of conditions, including headache, low back pain, rheumatoid arthritis, knee pain and neck pain. There is not a large volume of scientific evidence supporting the effectiveness of acupuncture, but many patients experience relief from acupuncture treatments. Acupuncture may provide significant additional relief in neurogenic TOS patients receiving other conservative treatments. Most states require non-physician acupuncturists to pass a qualifying examination.
Massage therapy performed in conjunction with other conservative treatments may increase effectiveness of those treatments. Scientific studies of massage therapy are often preliminary and conflicting. However, there is some evidence that massage therapy may provide relief for patients with chronic neck pain or low back pain, knee pain, or depression. Massage therapists are regulated in most states.
Gage and Parnell in 1947 likely performed the first anterior scalene block. In 1998, the procedure was revisited by Jordan and Machleder. Currently. a number of TOS surgeons rely on this procedure to make surgical decisions.
A doctor performs a scalene block by injecting a medication into the anterior scalene muscle. Doctors may choose a short-acting anesthetic for diagnostic purposes, or a longer-acting agent for temporary relief of pain. In addition to the anterior scalene muscle, some doctors inject the middle scalene muscle, the subclavius muscle, or the pectoralis minor muscle.
No clear evidence has been published regarding the mechanism that creates relief of symptoms from these injections. There are varying levels of evidence regarding the effectiveness of these injections. Nonetheless, at least empirically, many TOS patients do experience relief from these injections.
More discussion to follow regarding these injections.