Pectoralis Minor Trigger Points

Introduction

The pectoralis minor is a deep chest muscle responsible for shoulder stability, rib movement, and breathing support. When trigger points develop in this muscle, they can cause chest pain, shoulder tightness, and arm numbness, often mimicking thoracic outlet syndrome, rotator cuff dysfunction, or heart-related pain.

Name and Area

  • Name: Pectoralis Minor

  • Area: Located beneath the pectoralis major, running from the ribs (3rd–5th) to the coracoid process of the scapula.

Indications

Pectoralis minor trigger points may contribute to:

  • Pain in the Chest, Shoulder, and Inner Arm (Mistaken for Heart Pain or Rotator Cuff Issues)

  • Pain That Radiates Down the Arm and Into the Hand (Can Mimic Thoracic Outlet Syndrome or Nerve Compression)

  • Tightness in the Chest That Restricts Deep Breathing (Common in Stress and Anxiety-Related Muscle Tension)

  • Pain or Numbness That Increases with Slouched Posture or Prolonged Sitting

  • Shoulder Blade Tightness or Discomfort, Especially After Carrying a Bag or Backpack

  • Pain That Worsens with Overhead Movements or Pushing Exercises (Common in Weightlifters and Swimmers)

Pain from this muscle is often mistaken for thoracic outlet syndrome, rotator cuff injuries, or heart-related conditions.

Muscle Action

  • Protracts the Scapula: Pulls the shoulder blade forward, important for pushing and reaching movements.

  • Stabilizes the Shoulder: Supports scapular movement and posture.

  • Assists in Deep Breathing: Elevates the ribs during forceful inhalation.

The pectoralis minor is essential for shoulder positioning, breathing mechanics, and upper body function.

Signs and Symptoms

Individuals with pectoralis minor trigger points often report:

  • Pain in the Chest That Feels Like a Deep Ache or Tightness (Can Mimic Cardiac Pain or Costochondritis)

  • Pain or Numbness Down the Arm, often into the Pinky and Ring Fingers (Can Resemble Thoracic Outlet Syndrome or Ulnar Nerve Compression)

  • Tightness in the Front of the Shoulder, Leading to Poor Posture and Rounded Shoulders

  • Difficulty Taking Deep Breaths (Can Feel Like Rib Restriction or Shallow Breathing)

  • Pain That Worsens with Overhead Movements, Push-Ups, or Heavy Lifting

  • Discomfort When Carrying a Heavy Bag on One Shoulder (Common in Students and Office Workers)

Pain worsens with poor posture, repetitive pushing movements, or prolonged forward shoulder positioning.

Perpetuating Factors

Common causes of pectoralis minor trigger points include:

  • Forward Shoulder Posture (Common in Desk Workers, Gamers, and Cyclists)

  • Repetitive Pushing Movements (Weightlifting, Boxing, Swimming, Tennis, or Throwing Sports)

  • Carrying Heavy Bags or Backpacks (Leads to Overuse and Strain in the Pectoralis Minor)

  • Shallow Breathing or Chronic Stress (Increases Chest Muscle Tension and Restricts Rib Expansion)

  • Prolonged Sitting Without Shoulder Support (Common in Office Workers and Drivers)

Trigger Point Referral Pattern

Trigger points in the pectoralis minor refer pain to:

  • The chest and upper ribs (Can Mimic Heart Pain or Costochondritis)

  • The shoulder and down the arm (Mistaken for Thoracic Outlet Syndrome or Rotator Cuff Pain)

  • The inner forearm and hand (Can Resemble Ulnar Nerve Compression or Carpal Tunnel Syndrome)

Pain from this muscle is often confused with nerve compression, rotator cuff dysfunction, or cardiovascular conditions.

Differential Diagnosis

Pectoralis minor trigger points may be mistaken for:

  • Thoracic Outlet Syndrome (Pain, Numbness, or Weakness in the Shoulder and Arm Due to Nerve or Vascular Compression)

  • Rotator Cuff Dysfunction (Shoulder Pain That Worsens with Overhead Activities or Lifting)

  • Costochondritis (Chest Pain Due to Rib Cartilage Inflammation, Worse with Deep Breathing or Movement)

  • Heart Issues (Angina or Cardiac-Related Chest Pain That Occurs with Physical Activity or Stress)

  • Carpal Tunnel Syndrome (Pain or Numbness in the Hand, Often Worse at Night or With Repetitive Movements)

A thorough chest, shoulder, and nerve assessment is necessary to rule out these conditions.

Associated Trigger Points

Pectoralis minor trigger points often co-exist with:

  • Pectoralis Major (Chest and Shoulder Pain, Common in Athletes and Overhead Workers)

  • Serratus Anterior (Rib and Side Pain, Affects Deep Breathing and Shoulder Stability)

  • Upper Trapezius (Neck and Shoulder Tension, Contributes to Postural Strain and Headaches)

  • Subscapularis (Deep Shoulder Pain and Limited Rotation, Common in Overhead Athletes)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Pectoralis Minor Ribs 3–5 Coracoid process of the scapula Medial pectoral nerve (C8–T1)

The pectoralis minor is innervated by the medial pectoral nerve, which also controls shoulder stability and scapular movement.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the chest, ribs, and coracoid process.

  • Resisted Shoulder Protraction Testing: Assess pain and weakness when moving the shoulder blade forward against resistance.

  • Postural Analysis: Look for rounded shoulders, forward head posture, or excessive chest tightness.

  • Thoracic Mobility Testing: Rule out rib dysfunction or thoracic outlet compression.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the pectoralis minor, reducing chest tightness and improving shoulder mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the chest and shoulder.

  • Massage Therapy: Helps improve circulation and reduce pectoral muscle tension.

Stretching

  • Chest Opener Stretch (Doorway Stretch): Stand in a doorway, place one hand on the frame, and gently turn away to stretch the pectoralis minor.

  • Foam Roller Thoracic Stretch: Lie on a foam roller with arms outstretched to open the chest and relieve tension.

Strengthening Exercises

  • Scapular Retraction Drills: Helps counteract pectoral tightness by strengthening the upper back.

  • Face Pulls: Encourages proper shoulder posture and prevents excessive forward shoulder position.

  • Wall Angels: Improves thoracic mobility and postural alignment.

Postural and Movement Adjustments

  • Avoid Prolonged Slouching (Maintain a Neutral Spine and Open Chest Position While Sitting and Standing)

  • Ensure Proper Form During Pushing Exercises (Engage the Core and Avoid Overloading the Pectorals)

  • Practice Deep Breathing Exercises (Encourages Proper Rib Expansion and Chest Relaxation)

Conclusion

The pectoralis minor plays a crucial role in shoulder stability, breathing, and posture, but trigger points in this muscle can cause significant chest, shoulder, and arm pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent postural dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.