The Scalene Muscles

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 are sometimes 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.

 

scalene_ant_post_pain_skeleton3

Scalenes muscles cause pain around the shoulder blade and may cause some pain and tingling around the elbow. The wrist, thumb, and finger symptoms can range from numbness and tingling to pain.

Contents of Article

What pain and symptoms are associated with the scalene muscles?

Though the muscles are located in the back of the neck, trigger points in the scalenes only 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 pad area of the thumb 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 feel as if it is extending into the chest from 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 and contribute to 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 symptoms of TOS 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.

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Where are the scalene muscles?

The Scalene muscles are a group of muscles consisting of the scalenus anterior, scalenus medius, scalenus posterior, and 30% 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


Scalene Muscles

The scalene anterior, middle scalene, and posterior scalene.  The scalene minimus muscle is not shown.

What Causes Trigger Points In the Scalenes?

Whiplash and Fall Injuries

Whiplash injuries of the neck affect the scalene muscles and usually cause the development of 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.

TWD Recommends:

The Craniocradle was developed to help decompress joints and help muscles to relax. It works well for scalene muscle dysfunction including injuries caused by a fall or whiplash. The cradle can also be used for treatment on other areas including the low back and hip area. Instructions are provided.

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 it is likely the muscles are stressed and have developed trigger points. Bouts with bronchitis and pneumonia that not only affect breathing but also bouts of coughing will cause trigger points. People who have hyperventilated will often experience symptoms of trigger points.

The Huggaroo Neck Wrap is a large wrap that will treat neck, upper shoulder, and upper back muscle pain. It can be used cold for injury and swelling or warmed for deep penetrating heat. Works well to treat the scalene muscles and reduce the muscles pain and symptoms.

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 while the muscles on the other side are overstretched which sets up a muscle imbalance which 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 are carried out over the body affects all the muscles of the neck, shoulders, chest, and upper back. Forward head posture keeps the scalenes in a constantly stretched position which again will cause trigger points to develop.


If you have rounded shoulders, forward head posture, or have a habit of slouching, correcting your posture will reduce your muscle pain. I  recommend the HailiCare Posture Corrector The corrector fully supports the back and abdominal area while gently pulling your shoulders back which helps retrain muscle memory to maintain proper posture. Start slowly, wearing the brace only 20-30 minutes a day slowly increasing the time you wear it.

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.

I use and often recommend the Neck King Massage Tool to my clients who have problems due to dysfunction in the neck muscles. The Neck King works on trigger points and pressure points to help relieve muscle tension and pain. The secret to using the Neck King is to follow the directions carefully and to slowly build up the time spent using the tool. For many first time users, the tool is too hard to use comfortably. Folding a hand towel and laying it over the Neck King will help ease the discomfort. This tool has helped me as well as many of my clients relieve pain and symptoms due to problems within the neck muscles.

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 are the individual muscle trigger point treatments that 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. If you suffer from TOS and shoulder, arm, and hand pain I highly recommend this book. 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.

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The best resource to learn how to treat small painful knots is The Trigger Point Therapy Workbook. The authors explain trigger points and their effects in everyday language, not medical speak. I recommend this book to anyone interested in learning to treat their own muscle pain.

Sombra Warm Therapy Gel is recommended for relaxing muscles and relieving pain. It warms without the burning heat of other gels. An excellent choice for pain caused by trigger points, muscle/joint over-use and stiffness, and arthritis. (Not sold in stores)

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 is sometimes misdiagnosed as thoracic outlet syndrome or carpal tunnel syndrome.

TWD Recommends:

Biofreeze Professional Gel is what I recommend for whiplash and symptoms of muscle strains. It provides excellent pain relief and may help reduce inflammation caused by a strain and injuries. Recommended by medical professionals and trainers. 

Clinical diagnoses to which the scalene muscles symptoms may contribute:

  • 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
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