Skip to content

Scalene Muscles: Neck, Shoulder, Chest, Upper Back, Arm, Pain

The scalene muscles consist of 3 muscles, the anterior scalene, the middle scalene, and the posterior scalene.

Trigger points in the scalenes contribute to wide-ranging pain and symptoms in the shoulder, upper back, chest, arm, and hand. Numbness and tingling sensations may be experienced in the affected areas. Swelling in the arm and hand are occasionally observed.

The muscles are involved in thoracic outlet syndrome (TOC). If you have been diagnosed with TOC, you should check the muscles for trigger points.

Contents of Article

    Where are the scalene muscles?

    Scalene Muscles Showing Trigger Point Locations

    The Scalene muscles are a group of muscles consisting of the scalenus anterior, scalenus medius, and scalenus posterior. Thirty percent of people have a fourth muscle, the scalene minimus. These muscles are located toward the side of the neck and attach the neck vertebrae to the 1st and 2nd ribs.

    What movements do the scalene muscles control?

    • Raises 1st and 2nd ribs during inhalation
    • Side bends the neck, ear to shoulder motion
    • Turns the head side to side

     For detailed anatomy information see:  Scalene Muscles Anatomy


    What pain and symptoms are associated with the scalene muscles?

    Scalene Muscles Pain Pattern

    Though the muscles are located in the back of the neck, trigger points in the scalenes rarely cause pain in the neck. A classic symptom of trigger points in the muscles is a twitching, jerking, and restless feeling in the neck and shoulder. The sensations are compared to those of restless leg syndrome.

    Trigger points in the muscles can send pain into the shoulder and around the inside edge of the shoulder blade. The pain often travels down the arm into the thumb's pad area, spilling over into the index finger and sometimes the second finger. You may also experience tingling, numbness, and occasionally swelling in the arm and hand.

    You may also experience pain in the upper chest which may extend to the shoulder.

    The Scalene Minimus

    Approximately 30% of the population has a fourth scalene muscle called the scalenus minimus. The muscle is found between the scalene anterior and the middle scalene.  This rare and small muscle can cause pain in the upper arm, forearm, all five fingers, and the thumb.

    The Scalene Muscles Are A Major Contributor To Thoracic Outlet Syndrome
    Thoracic Outlet Syndrome (TOS) happens when the nerves and/or blood vessels running from the neck down into the arm are compressed between the first rib and collarbone. The most notable TOS symptoms are pain in the shoulder extending into the arm and down into the hand. Numbness, tingling, and occasionally swelling in the affected arm and hand are common, as well as a loss of strength and grip on the affected side.

    TWD Recommends

    Scalene muscle tightness and pain respond well to hot and cold treatments. The Huggaroo Neck Wrap treats the neck, top of the shoulder, and upper back. It can be chilled for injuries and muscle strains or warmed to ease stress and help muscles relax.

    What Causes Trigger Points In the Scalenes?


    Whiplash and Fall Injuries

    Whiplash injuries of the neck affect the scalene muscles and usually cause trigger points in the muscles. If you have ever experienced a whiplash injury, you should check all the scalene muscles for trigger points.

    Falls in which you land with your head and neck in a twisted position will cause trigger points. It may be days, weeks, or even months before the symptoms occur, and you may not connect the pain to your fall. Again, check the scalenes and other neck muscles for trigger points after a fall.

    Difficulty Breathing, Coughing, and Hyperventilation

    The scalene muscles pull the ribs up, allowing the lungs to fill with air. If you suffer from asthma, emphysema, or allergies, the muscles are likely stressed and have developed trigger points. Bronchitis and pneumonia that affect breathing and cause bouts of coughing will cause trigger points. People who have hyperventilated will often experience symptoms of trigger points.

    Poor Head and Neck Posture

    Sleeping on your stomach, doing data entry with your head turned to the side while typing, or habitually holding your head tilted to the side puts incredible stress on the scalene muscles. The muscles on the side to which the head is turned become shortened. In contrast, the muscles on the other side overstretch, which sets up a muscle imbalance that contributes to headaches, shoulder, and arm pain, along with TrPs in the neck muscles, including the scalenes.

    Forward Head Posture
    Forward head posture, where the chin and head stick out in front of the body, affects all the neck, shoulders, chest, and upper back muscles. Forward head posture keeps the scalenes in a constantly stretched position which again will cause trigger points to develop.

    TWD Recommends
    If you have rounded shoulder, forward head posture, or a habit of slouching, correcting your posture will reduce muscle pain. The Truweo Posture Corrector is adjustable and comfortable. It gently pulls your shoulders back, which helps retrain muscle memory to maintain proper posture. Many people notice an immediate reduction of pain and tension. Start slowly, wearing the brace for short periods throughout the day, gradually increasing the time-worn.

    Lifting and Carrying Heavy Objects
    If you lift or pull heavy items using your back, shoulder, and arm muscles, the scalene muscles tighten and become strained. Be sure to use your leg muscles for strength and power when lifting, pulling, and carry heavy objects.

    Heavy Purses, Backpacks, and Briefcases
    When you carry a heavy purse, briefcase, or a backpack on one shoulder, it pulls the shoulder down, which causes the muscles of the neck, shoulder, chest, and upper back to tighten, trying to keep your shoulder in a neutral position. Over time these muscles become stressed, causing muscle strains and trigger points.

    Neck Ties
    Tight neckties can restrict blood flow and put pressure on the nerves and muscles of the neck. If you wear a necktie often, make sure it is not too tight and loosen it when you can.

    TWD Recommends

    Does your pillow support your head and neck?

    Sleeping without proper head and neck support will aggravate the scalene muscles and other neck and shoulder muscles. The Sweetnight Pillow has adjustable filling and is highly recommended for its neck support.

    Scalene Muscles Trigger Point Treatment

    If you are suffering from thoracic outlet syndrome, stinging burning pain and numbness down the arm, or any of the other symptoms of trigger points in the scalene muscles, consider Claire Davies The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. Mr. Davies explains the trigger point phenomenon and muscle pain in everyday language. But what makes this book worth its weight in gold is the individual muscle trigger point treatments Davies has compiled. His diagrams and step-by-step instructions help you locate which muscles are contributing to your pain, how to find the trigger point and treat it. It takes time and practice to master finding trigger points, but once you learn, you have a tool and method to help relieve muscle pain throughout the body. I highly recommend this book if you suffer from TOS and shoulder, arm, and hand pain. Relieving trigger points in the three scalene muscles have helped many people resolve TOS and their pain issues. This book is a must-have for anyone interested in finding the cause and treating muscle pain.

    Biofreeze Pain Relieving Gel is an excellent pain-relieving gel, and I recommend it for those who have sudden onset muscle pain or recent injuries.  It is better than warm therapy gels and creams for recent injury muscle pain as it cools the area much like ice and does not promote swelling.   Biofreeze is recommended for those who have had a recent neck injury or sudden onset pain. Rub Biofreeze into the upper back and shoulders, into the front, side, and back of the neck, going up to the base of the skull and over behind the ears.  Highly recommended for early treatment of whiplash.

    Sombra Warm Therapy Pain Relieving Gel is a pain-relieving gel that I use personally and professionally in my massage therapy practice. Unlike other over-the-counter heating creams, it provides warmth without burning heat. It can help reduce tightness and pain in the back of the neck and the base of the skull, often caused by the sternocleidomastoid muscles. Applying Sombra to the back and sides of the neck, up behind the ears, and along the base of the skull will help headache and whiplash pain caused by the sternocleidomastoid muscles.

    How Long Before I Feel A Reduction In Pain?

    Trigger points in the scalene muscles can be stubborn and take several days of treatments before noticing a positive change. You must stay with the treatment program to rid the muscle(s) of trigger points.  Consistent treatments several times a day for 1-2 minutes per treatment until the trigger point(s) can no longer be felt is necessary for successful treatment.

    TWD Recommends

    The Craniocradle treats headaches and stiff necks. The cradle applies pressure to the muscles while providing gentle traction to the neck. Use for 5-10 minutes and feel a reduction in pain and stress. You can also use the cradle to treat other areas, including the low back and hip area.

    Interesting Facts About The Scalene Muscles

    • In about 30% of the population, another scalene muscle, the scalenus minimus, is found. The scalenus minimus is often only found on one side of those who have this ‘extra’ muscle.
    • The scalene muscles are seldom painful yet refer pain throughout the chest, upper back, shoulders, arms, and neck.
    • Symptoms caused by scalene muscle dysfunction are sometimes misdiagnosed as thoracic outlet syndrome or carpal tunnel syndrome.

    Scalene muscle pain and symptoms can be similar to, contribute to, and be affected by these medical diagnoses:

    • Thoracic outlet syndrome
    • C4 C5 C6 C7 or C8 radiculopathy
    • Subacromial tendinitis
    • Bicipital tendinitis
    • Subacromial tendinitis
    • Lateral epicondylitis
    • Tennis Elbow
    • Spasmodic torticollis (Wryneck syndrome)
    • Carpal tunnel syndrome
    • Costoclavicular syndrome (Cervical rib syndrome)


    Other muscles that should be considered and examined in conjunction with the scalenes:

     Satellite trigger points associated with the scalene muscles:

    If you find trigger points in the scalene muscles you will want to check these muscles for additional trigger points.
    • Sternocleidomastoid
    • Pectoralis major
    • Pectoralis minor
    • Levator scapulae
    • Trapezius
    • Splenius capitis
    • Triceps Brachii

    TWD Recommends

    Doctors and physical therapists often recommend TENS to relax muscles and ease the pain. The Belifu TENS Unit Muscle Stimulator is an excellent choice for treating neck, shoulder, and arm pain.

    Muscles with similar pain patterns

    Subclavius Muscle
    Coracobrachialis Muscle