Scalene Trigger Points

Introduction

The scalene muscles are a group of deep neck muscles responsible for neck movement, rib elevation, and assisting in breathing. When trigger points develop in these muscles, they can cause neck pain, shoulder tightness, and arm numbness, often mimicking thoracic outlet syndrome, cervical radiculopathy, or carpal tunnel syndrome.

Name and Area

  • Name: Scalene Muscles (Anterior, Middle, and Posterior)

  • Area: Located deep in the neck, running from the cervical vertebrae (C2–C7) to the first and second ribs.

Indications

Scalene trigger points may contribute to:

  • Pain in the Side of the Neck That Extends to the Shoulder (Mistaken for Trapezius Strain or Cervical Disc Issues)

  • Pain or Numbness That Travels Down the Arm to the Hand (Can Mimic Thoracic Outlet Syndrome or Carpal Tunnel Syndrome)

  • Tightness in the Front of the Neck That Restricts Head Movement and Rotation

  • Pain That Increases with Deep Breathing or Overhead Arm Movements

  • Tingling or Weakness in the Hand and Fingers (Common in Those with Poor Posture or Shoulder Tension)

  • Pain That Worsens with Stress, Forward Head Posture, or Prolonged Desk Work

Pain from these muscles is often mistaken for nerve compression, rotator cuff dysfunction, or cervical spine disorders.

Muscle Action

  • Flexes the Neck: Moves the head forward and laterally, essential for posture and mobility.

  • Elevates the First and Second Ribs: Assists in breathing and deep inhalation.

  • Stabilizes the Cervical Spine: Helps maintain neck alignment and control movement.

The scalene muscles are crucial for neck stability, breathing mechanics, and upper limb function.

Signs and Symptoms

Individuals with scalene trigger points often report:

  • Pain in the Side of the Neck and Shoulder That Feels Like a Deep, Aching Sensation

  • Pain That Radiates Down the Arm to the Fingers (Can Mimic Thoracic Outlet Syndrome or Nerve Compression)

  • Weakness in the Hand or Forearm (Difficulty Gripping Objects or Maintaining Dexterity)

  • Pain or Tightness That Worsens with Deep Breathing, Stress, or Poor Posture

  • Headaches That Originate from the Neck and Extend to the Temples or Behind the Eyes

  • Pain That Feels Worse When Carrying a Heavy Bag on One Shoulder

Pain worsens with forward head posture, prolonged sitting, or repetitive arm movements.

Perpetuating Factors

Common causes of scalene trigger points include:

  • Forward Head Posture (Common in Desk Workers, Gamers, and Smartphone Users)

  • Chronic Stress or Anxiety (Can Lead to Increased Neck and Shoulder Tension)

  • Frequent Overhead Movements (Lifting, Painting, Rock Climbing, or Swimming)

  • Shallow Breathing Patterns (Overuse of the Scalenes to Assist in Breathing)

  • Carrying Heavy Bags or Backpacks (Can Overload One Side of the Neck and Shoulder)

Trigger Point Referral Pattern

Trigger points in the scalene muscles refer pain to:

  • The side of the neck and upper shoulder (Can Mimic Trapezius Strain or Cervical Disc Pain)

  • The chest and upper ribs (Mistaken for Pectoral Tightness or Thoracic Outlet Syndrome)

  • The arm and hand (Can Resemble Nerve Compression or Carpal Tunnel Symptoms)

Pain from these muscles is often confused with cervical radiculopathy, rotator cuff dysfunction, or thoracic outlet syndrome.

Differential Diagnosis

Scalene trigger points may be mistaken for:

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

  • Cervical Radiculopathy (Pain and Nerve Symptoms That Radiate from the Neck to the Arm and Fingers)

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

  • Rotator Cuff Dysfunction (Pain and Weakness in the Shoulder, Affects Overhead Movements)

  • Costochondritis (Pain in the Upper Ribs, Worsens with Deep Breathing or Movement)

A thorough cervical spine, shoulder, and upper limb examination is necessary to rule out these conditions.

Associated Trigger Points

Scalene trigger points often co-exist with:

  • Sternocleidomastoid (SCM) (Neck and Head Pain, Can Mimic Migraines or Sinus Issues)

  • Trapezius (Upper Back and Shoulder Tension, Common in Postural Strain and Stress-Related Pain)

  • Pectoralis Minor (Chest and Shoulder Pain, Can Contribute to Thoracic Outlet Syndrome)

  • Levator Scapulae (Neck and Shoulder Stiffness, Common in Postural Imbalances and Chronic Tension)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Anterior Scalene Transverse processes of C3–C6 First rib Cervical spinal nerves (C4–C6)
Middle Scalene Transverse processes of C2–C7 First rib Cervical spinal nerves (C3–C8)
Posterior Scalene Transverse processes of C4–C6 Second rib Cervical spinal nerves (C6–C8)

The scalene muscles are innervated by the cervical spinal nerves (C3–C8), which also control neck movement, rib elevation, and breathing mechanics.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the side of the neck and near the collarbone.

  • Resisted Side Bending and Rotation Testing: Assess pain and weakness when tilting the head laterally or rotating the neck against resistance.

  • Thoracic Outlet Syndrome Tests: Check for vascular or nerve compression by monitoring pulse changes and nerve function.

  • Postural and Breathing Analysis: Look for forward head posture, rounded shoulders, or excessive neck tension.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the scalene muscles, reducing neck tightness and improving shoulder function.

Manual Therapy

  • Trigger Point Release: Apply gentle sustained pressure along the side of the neck and upper shoulder.

  • Myofascial Release: Helps improve circulation and reduce muscle tension around the neck and clavicle.

Stretching

  • Neck Side Stretch: Tilt the head to one side while keeping the shoulders relaxed to stretch the scalene muscles.

  • Chest and Shoulder Stretch: Open the chest to reduce forward shoulder posture and neck strain.

Strengthening Exercises

  • Chin Tucks (Neck Postural Training): Helps reduce forward head posture and improve cervical alignment.

  • Scapular Retraction Drills: Strengthens the upper back to counteract scalene overuse and forward posture.

Postural and Behavioral Adjustments

  • Avoid Prolonged Forward Head Posture (Keep Screens at Eye Level to Reduce Neck Strain)

  • Use Proper Ergonomics While Sitting (Ensure Good Posture and Shoulder Alignment)

  • Practice Deep Diaphragmatic Breathing (Reduces Overuse of the Scalenes for Rib Elevation)

Conclusion

The scalene muscles play a crucial role in neck stability, breathing, and upper limb function, but trigger points in these muscles can cause significant neck pain, shoulder tightness, and arm numbness. By incorporating dry needling, manual therapy, stretching, and posture correction, individuals can reduce pain, improve mobility, and prevent chronic neck 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.