Tight scalenes are often involved in thoracic outlet syndrome (TOS), in which compression of the nerves and blood vessels cause pain in the shoulders and neck and numbness in the fingers. The thoracic outlet is marked by the anterior scalene muscle anteriorly, the middle scalene posteriorly, and the first rib inferiorly. When the scalenes are hypertonic (overly toned), the axillary (subclavian) artery and brachial plexus can become entrapped, resulting in pain, swelling, numbness, tingling, and burning in the arm and hand.
- Acting unilaterally: lateral flexion of the cervical spine.
- Acting bilaterally: stabilization of the cervical spine against lateral movement; elevation of the first and second ribs to assist in inspiration.
Symptoms produced by the scalenes are easily misdiagnosed. "Restlessness in the neck and shoulder, a classic sign of scalene trigger points, is written off as a nervous tic. Pain referred from the scalenes to the chest is mistaken for angina. Pain sent to the shoulder is almost universally mislabeled as bursitis or tendinitis. Scalene-referred pain down the front and back of the upper arm is mistakenly treated as muscle strain. The pattern of scalene referral in the shoulder, arm, and hand may make a neurologist infer that a degenerated vertebra or collapsed disk is causing compression of a cervical nerve root. Scalene-induced weakness in the forearms and hands that makes you unexpectedly drop things is likely to be ascribed to a neurological defect. Unexplained "phantom pain" in an amputated arm or hand can actually be coming from scalene trigger points." [Excerpt from Clair and Amber Davies, The Trigger Point Therapy Workbook].
Trigger points are defined as tender, small contraction knots that typically refer pain, called "active" trigger points. Active trigger points are often caused by injury, muscular strain, and overuse. Travell and Simons define a trigger point as "a highly irritable localized spot of exquisite tenderness in a nodule in a palpable taut band of muscle tissue." Common massage techniques include effleurage, gliding, petrissage, grasping, and friction. Over time, the "active" trigger points will relax and refer less pain, tingling, and numbness. They will become "latent" and perhaps only tender locally to the touch. Although myofascial trigger points may be found in the muscle tissue or muscle fascia, trigger points in general may also be present in cutaneous, ligamentous, periosteal, and non-muscular fascial tissues.
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- paradoxical breathing (reverses the normal breathing pattern, and means that during inspiration, the chest contracts, and during expiration, it expands)
- chronic cough
- trigger points from patients with asthma or emphysema
- pulling or lifting, especially with the arms level at the waist
- chronic rotation of the cervical spine to one side
- carrying heavy loads or heavy backpacks
- sports activities
- forward head posture from activities such as using phone or tablet (text neck)
- habitual slouching posture
Davies, Clair and Amber. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. Oakland: New Harbinger Publications, Inc., 2004. Print.
Finando, Donna & Finando, Stephen. Trigger Point Therapy for Myofascial Pain: The Practice of Informed Touch. Rochester: Healing Arts Press, 2005. Print.
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“Scalenes Referred Pain.” Digital Photograph. Chicago Center for Myofascial Pain Relief, http://chicagotriggerpointcenter.com/clinic-services/what-is-trigger-point-therapy.