Subclavius Trigger Points
Introduction
The subclavius is a small but essential muscle responsible for stabilizing the clavicle, assisting in shoulder movement, and supporting breathing mechanics. When trigger points develop in this muscle, they can cause chest pain, shoulder tightness, and numbness in the arm, often mimicking thoracic outlet syndrome, rotator cuff dysfunction, or pectoral muscle strain.
Name and Area
Name: Subclavius
Area: Located beneath the clavicle (collarbone), running from the first rib to the clavicle.
Indications
Subclavius trigger points may contribute to:
Pain Below the Collarbone That Feels Like a Deep Ache (Mistaken for Pectoral Tightness or Rib Pain)
Pain That Travels Down the Arm to the Hand (Can Mimic Thoracic Outlet Syndrome or Nerve Compression)
Tightness or Restriction in Shoulder Movement (Difficulty Lifting or Reaching Overhead)
Numbness or Tingling in the Arm and Hand (Common in Those with Poor Posture or Forward Shoulders)
Pain That Increases with Deep Breathing or Chest Expansion (Can Resemble Intercostal Strain or Rib Dysfunction)
Discomfort When Carrying a Heavy Bag on One Shoulder (Can Cause Clavicular Compression and Nerve Irritation)
Pain from this muscle is often mistaken for thoracic outlet syndrome, rotator cuff dysfunction, or nerve irritation.
Muscle Action
Depresses the Clavicle: Moves the collarbone downward, important for shoulder and scapular mechanics.
Stabilizes the Clavicle: Prevents excessive movement of the collarbone during arm motion.
Assists in Breathing: Works with other chest muscles to support rib expansion and respiration.
The subclavius is crucial for clavicle stability, shoulder movement, and upper body mechanics.
Signs and Symptoms
Individuals with subclavius trigger points often report:
Pain Under the Clavicle That Feels Like a “Band” or “Tight Strap” Across the Chest
Numbness or Tingling That Radiates to the Arm and Hand (Can Resemble Nerve Compression in Thoracic Outlet Syndrome)
Difficulty Lifting the Arm Overhead or Reaching Across the Body
Pain or Tightness in the Shoulder That Feels Restrictive (Can Mimic Rotator Cuff Dysfunction)
Pain That Worsens with Deep Breaths, Coughing, or Chest Expansion
Discomfort After Carrying a Shoulder Bag or Wearing a Tight Bra Strap (Can Compress the Clavicle and Underlying Nerves)
Pain worsens with forward shoulder posture, repetitive shoulder movements, or prolonged carrying of heavy loads.
Perpetuating Factors
Common causes of subclavius trigger points include:
Forward Shoulder Posture (Common in Desk Workers, Gamers, and Cyclists)
Repetitive Shoulder Movements (Weightlifting, Swimming, Boxing, or Overhead Sports)
Carrying Heavy Bags or Wearing Tight Straps Over One Shoulder (Can Cause Clavicular Compression and Muscle Tightness)
Previous Clavicle Fractures or Shoulder Injuries (Can Lead to Chronic Subclavius Dysfunction)
Shallow Breathing or Stress-Related Tension (Can Cause Overuse of the Subclavius for Rib Expansion and Breathing Support)
Trigger Point Referral Pattern
Trigger points in the subclavius refer pain to:
The front of the shoulder and upper chest (Can Mimic Pectoral Muscle Strain or Rotator Cuff Pain)
The inner arm and down to the hand (Mistaken for Thoracic Outlet Syndrome or Nerve Entrapment)
The side of the neck and jaw (Can Resemble Sternocleidomastoid Dysfunction or Cervical Nerve Irritation)
Pain from this muscle is often confused with thoracic outlet syndrome, rotator cuff impingement, or nerve compression syndromes.
Differential Diagnosis
Subclavius trigger points may be mistaken for:
Thoracic Outlet Syndrome (Pain, Numbness, or Weakness in the Arm Due to Nerve or Vascular Compression in the Clavicular Region)
Rotator Cuff Dysfunction (Shoulder Pain and Weakness, Often Worsens with Overhead Movements)
Costochondritis (Pain and Tenderness Along the Ribs and Sternum, Worsens with Deep Breathing)
Cervical Radiculopathy (Neck Pain That Radiates to the Shoulder and Arm, Often Due to Nerve Compression in the Cervical Spine)
Pectoralis Minor Dysfunction (Chest and Shoulder Pain, Can Lead to Forward Shoulder Posture and Thoracic Outlet Symptoms)
A thorough clavicle, shoulder, and upper limb examination is necessary to rule out these conditions.
Associated Trigger Points
Subclavius trigger points often co-exist with:
Pectoralis Minor (Anterior Shoulder and Chest Tightness, Can Contribute to Thoracic Outlet Syndrome)
Sternocleidomastoid (SCM) (Neck and Shoulder Pain, Can Mimic Migraines or Nerve Irritation)
Upper Trapezius (Shoulder and Neck Tension, Common in Postural Strain and Stress-Related Pain)
Scalene Muscles (Neck and Rib Pain, Can Contribute to Breathing Dysfunction and Nerve Compression)
Anatomy and Innervation
| Muscle | Origin | Insertion | Innervation |
|---|---|---|---|
| Subclavius | First rib and costal cartilage | Inferior surface of the clavicle | Nerve to subclavius (C5–C6) |
The subclavius is innervated by the nerve to subclavius (C5–C6), which also controls clavicular movement, shoulder stability, and breathing mechanics.
Patient Examination
A comprehensive examination should include:
Palpation: Identify tender nodules along the clavicle and upper chest region.
Resisted Shoulder Depression Testing: Assess pain and weakness when pulling the shoulder downward against resistance.
Thoracic Outlet Syndrome Tests: Check for vascular or nerve compression by monitoring pulse changes and nerve function.
Postural and Breathing Assessment: Look for forward shoulder posture, rib tightness, or shallow breathing mechanics.
Corrective Actions
Dry Needling
Dry needling can release trigger points in the subclavius, reducing clavicular tension and improving shoulder function.
Manual Therapy
Trigger Point Release: Apply deep sustained pressure to tight spots along the clavicle and upper chest.
Myofascial Release: Helps improve circulation and reduce muscle tension in the anterior shoulder region.
Stretching
Chest Opener Stretch (Doorway Stretch): Helps release tension in the subclavius and pectoral muscles.
Shoulder Protraction Stretch: Encourages proper scapular mobility and clavicle alignment.
Strengthening Exercises
Scapular Stability Exercises (Wall Slides): Helps activate the serratus anterior and improve shoulder function.
Deep Breathing Drills: Encourages proper rib expansion and reduces chronic upper chest tension.
Postural and Movement Adjustments
Avoid Excessive Forward Shoulder Posture (Maintain Proper Scapular Alignment While Sitting and Standing)
Ensure Proper Breathing Mechanics (Diaphragmatic Breathing Can Reduce Overuse of the Subclavius for Respiration)
Use Ergonomic Workstation Adjustments (Prevents Forward Shoulder Posture That Can Exacerbate Clavicle Tightness)
Conclusion
The subclavius plays a crucial role in clavicle stability, breathing, and shoulder function, 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.