The anterior oblique muscle originates from the anterior nodes of the transverse processes of the 3rd to 6th cervical vertebrae and its fibers are directed downward and slightly outward, ending at the medial border of the 1st rib and the oblique nodes. The middle oblique muscle starts at the posterior node of the transverse process of the 1st or 2nd to 6th cervical vertebrae. It terminates behind the subclavian artery groove above the 1st rib. The posterior border of the anterior trapezius, the anterior border of the middle trapezius and the clavicle form the trapezius triangle. The brachial plexus nerve passes over the outer part of the oblique angle muscle triangle, and the subclavian artery and vein pass obliquely over the anterior and inferior parts of the triangle. The oblique muscle triangle is a narrow gap at the exit of the upper thorax. The spasm and edema of the oblique muscle due to tissue inflammation, trauma or provocation narrow the gap of the oblique muscle triangle even more, thus compressing and clamping the brachial plexus nerve and subclavian artery and vein through the gap and producing a series of symptoms. Anterior oblique muscle syndrome is one of the thoracic outlet syndromes. The symptoms include localized pain and mild swelling at the supraclavicular fossa of the neck, pain, numbness, and abnormal sensation in the distribution area of the ulnar nerve of the corresponding upper limb, and later on, muscle weakness, intrinsic hand muscle atrophy, glove-like sensory abnormalities in the distal part of the upper limb when the artery is compressed, cold and pale limbs, and cyanotic and rough skin. The disease is mostly caused by trauma, strain, congenital cervical ribs, and high ribs that stimulate the anterior oblique muscles, causing spasm, hypertrophy, and degeneration of the anterior oblique muscles. It occurs in people around 30~45 years old, more women than men, and more right than left. Causes: The common causes of anterior oblique muscle strain are as follows: the head and neck in lateral flexion, lateral tilt and other posture fixed position for too long. For example: writing, ambulatory work, reading, watching TV, playing mahjong, sitting in the car, etc., so that the anterior oblique muscle in a long time in a state of tension contraction, resulting in excessive fatigue and injury. Long time lifting heavy objects pulling. Because the object is heavy and the head must be to the opposite direction. This is under the action of external forces for a long time, it is easy to cause injury to the anterior oblique muscle. Pathological changes: According to clinical observation, most patients suffering from this disease are caused by cervical spondylosis. Due to cervical spine osteophytes and soft tissue around the cervical spine pathological changes, compression or stimulation of the cervical nerve roots, and the anterior oblique muscle is innervated by the nerves issued by the brachial plexus, thus causing the anterior oblique muscle reflex spasm, the anterior oblique muscle spasm will certainly traction elevation of the first rib, if the muscle spasm can not be released in a timely manner, the traction elevation of the first rib can be long-term chronic stimulation of the brachial plexus nerve bundle, and cause the anterior oblique muscle continuous If the spasm of this muscle is not relieved in time, the traction-raised first rib can chronically stimulate the brachial plexus nerve bundle for a long period of time, causing continuous spasm of the anterior oblique muscle, followed by hypertrophy of the muscle belly. This spastic muscle further elevates the first rib to aggravate the stimulation of the brachial plexus nerve, forming a vicious circle. Because of the spasm of this muscle, the traction of the elevated first rib and the lack of elasticity near the termination of this muscle are tough, so they must compress the lower brachial plexus and the subclavian artery that pass through this area, which then leads to a series of clinical symptoms. Clinical symptoms: ①History of neck and arm pain, numbness, soreness, coldness, abnormal sensation and unfavorable activity; ②Sensory impairment is obvious in the medial forearm and ring finger and little finger, with obvious pressure pain between the oblique muscles and radiation to the upper extremity, which may be accompanied by muscle weakness, muscle atrophy and weakened or unevoked tendon reflexes of the affected limb; ③Tense, hypertrophied and hard anterior oblique muscles can be felt in the front of the neck, with obvious local pressure pain and radiation to the upper extremity of the affected side. (3) Tension, hypertrophy, and stiffness of the anterior oblique muscle belly can be felt at the front of the neck, with obvious local pressure pain and radiation to the affected upper limb. (5) No congenital anomalies such as abnormal cervical ribs, thoracic ribs, or overgrown transverse processes of the 7th cervical vertebra were found on the X-ray frontal and lateral cervical spine radiographs. Diagnosis: The disease is most common in middle-aged women; characteristic pain with upper limb sensory abnormalities or (and) circulatory abnormalities; pressure pain and radiating pain in the anterior oblique muscle on the side of the lesion; positive deep breathing test (Adson); local infiltration block of the anterior oblique muscle belly can relieve pain; no positive signs in the frontal and lateral radiographs of the cervical and thoracic segments. Conservative Chinese medicine treatment: a. Acupoint injection: 2ml of 1% procaine hydrochloride, plus 100μg of vitamin B12, take the cervical arm point, i.e. 1 inch above the junction of the inner 1/3 and outer 2/3 of the clavicle, and avoid the blood vessels at the posterior edge of the clavicular head of the sternocleidomastoid muscle to enter the needle, wait until there is a feeling of getting gas under the needle after pumping without returning blood, then slowly push in the liquid. Every 5 d / 1 time. Acupuncture point injection treatment is to effectively block the vicious cycle of muscle tissue irritation – spasm – re-irritation through its function of dredging the meridians and activating blood circulation, dispersing nodes and relieving pain, so as to achieve the treatment purpose. Massage: Relieve the spasm of the muscle, reduce the pressure on the neurovascular bundle and relieve the symptoms caused by sympathetic nerve involvement. The doctor stands behind the patient and pushes the neck, shoulder, back and sternocleidomastoid muscle with both hands, then apply the rolling method, lift the upper limb of the affected side of the patient, make the shoulder muscles on the patient’s side fully relaxed, together with the upper arm on the affected side, apply the rolling method, then pinch the neck muscles, press the Fengchi, Fengfu and shoulder well points for about 8 minutes, then use the big fish interval of one hand to press and knead along the sternocleidomastoid muscle from top to bottom several times, use the thumb to press along the sternocleidomastoid muscle belly Then use both thumbs to press the top-to-bottom pinch along the anterior and posterior edges of the sternocleidomastoid muscle belly, and press the ecliptic, futu, tianding, and incompetent points, press the lack of pelvic points for about 1 minute to make the affected upper extremity feel sore, numb, and swollen, then use both thumbs to press the tianzong and zhongfu points for about 1 minute, again making the affected upper extremity feel sore, numb, and swollen, then relax and press the points to make the affected upper extremity feel warm, and finally press the jiquan, quchi, hegu, and nei guan points, finger paddle the axillary nerve and The treatment time is about 20 minutes. Feng’s spine fixed point rotation reset method: the injury of the anterior oblique muscle is often combined with the rotational displacement of the small joints of the cervical spine and changes in the cervical curve. Through manipulation to correct the skewed spinous process, restore the biomechanical balance of the cervical spine. The Feng’s spinal fixed-point rotational repositioning method is performed twice a week. During the treatment period, the patient is instructed to perform resistance shoulder lift exercises, which can improve the posture to open up the cervicothoracic outlet. Specifically, the patient should take a sitting position with reduced cervical anterior convexity, slowly repeat and fully perform resistance shoulder lift, gradually increasing the resistance and the number of repetitions. In addition, the patient is instructed to adopt the abducted affected limb position when resting. Traction: situational cervical anterior flexion traction, traction time 20min, weight 6~7kg. V. Isometric contraction exercise treatment: patient in sitting position, doctor standing behind the patient, patient’s head flexed to the affected side, shrugging the affected shoulder, doctor’s hands doing resistance exercise, lasting 10s, interval 1min, repeat the above exercise 3 times, 1 time/d, 5 times for a course of treatment. Isometric contraction exercise is a kind of centrifugal-centripetal compound contraction exercise, which can loosen muscle spasm and myalgic involvement pain, and achieve the purpose of treating diseases caused by muscle spasm. Interosseous groove brachial plexus nerve block method: Inject the needle at the higher position of the interosseous groove in the anterior middle oblique angle, after finding the foreign sensation, draw back no cerebrospinal fluid and blood that is fixed needle, inject prednisolone 1.5ml, dexamethasone 5mg plus 2% lidocaine 5ml mixture, the injection speed can be a little faster, after injection, gently rub the interosseous groove to make the drug spread rapidly. When the local anesthetic is effective and the pain is relieved, the patient is instructed to move the affected shoulder and neck, and the physician massages the anterior middle oblique muscle with light techniques. During the treatment period, the patient is given oral vitamin B and Chinese herbal medicines to relax the tendons and activate the blood. Sealing once every 5~7 days, 1~3 times for 1 course of treatment. Seven, electroacupuncture treatment: (1) take the affected side of the Tian Ding point, straight stab 0.5~0.8 inch, do a small amplitude of lifting and twisting after there is the sensation of the needle running to the shoulder and arm, continue to perform the needle for 1 minute and then exit the needle. (2) Take the affected side of shoulder well, shoulder middle Yu, shoulder outer Yu, tianxiu, futu, manbai and qishe, and after acupuncture into the acupuncture points to obtain qi, keep the needles for 25 minutes. The needle shank is connected to the electroacupuncture instrument, and the current is taken as dense and sparse as the patient can tolerate. The treatment was performed once a day, 12 times for a course. Tian Ding point is a hand Yang Ming meridian point, its deep layer is the starting point of anterior oblique muscle, local acupuncture can relieve the spasm of anterior oblique muscle. Electroacupuncture stimulates the acupuncture point by low-frequency pulse current, which promotes the metabolism of nerve tissue and facilitates the removal of inflammatory products. Modern research shows that bloodletting can regulate small blood vessel diastole, so that the tissues can get more adequate blood nutrition and repair as soon as possible. After the pricking and bloodletting treatment, the swollen or spastic anterior oblique muscle can quickly return to normal form and release the compression on blood vessels and nerves.