Those naughty Scalenes

If there is one muscle group that must be evaluated in every case of hand and arm pain, it is the group of three neck muscles called the Scalenes.  Taking a look at the areas of referred pain (shaded in red below) from trigger points in this muscle group, we see that the entire length of the arm from the shoulder down into the fingers can be affected.  Also, notice the extremely common area of pain that brings many patients into the office – right between the shoulder blade and the spine!

Even more significant, the major nerves and arteries that run down your arm pass through a small opening between the Scalenes.  When the Scalenes are tight and shortened, there is a risk of compressing those nerves and impairing blood flow to your arm and hand.  Conditions such as Thoracic Outlet Syndrome and Carpal Tunnel Syndrome can be directly caused or contributed to by this Scalene compression.  The ability of the Scalenes to trap and compress nerves and blood vessels led Dr. Janet Travell (physician to JFK) to give them the nickname, “The Entrappers.”
If you experience tightness or pain in any of the shaded referred pain areas, you have swelling in your hands, and/ or you experience any numbness or tingling in your hands and arms, please perform the following quick tests and self-care tips below to identify possible trigger points and myofascial dysfunction in your Scalenes.*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional.  Please consult your physician to determine whether these self-care tips are appropriate for you.

(3) Quick Self-Tests to Tell if You have Trigger Points in Your Scalenes:

Follow the instructions below to test whether myfoscial trigger points in your Scalenes might be causing your hand and arm symptoms.

TEST 1:  Scalene Finger Flexion 

While seated or standing, raise your arm to 90 degrees with your elbow also bent to 90 degrees (as shown).  Fold your fingers down so that the pads of your fingers touch your hand.  Make sure the wrist and fingers are straight. A Passing result is if all the fingers touch the hand.

A  Not Passing result is if one or more fingers cannot reach the hand (keeping wrist and fingers straight), indicating trigger points in the Scalenes.

TEST 2:  Lateral Flexion

 PASS                                      NOT PASSING

Standing or sitting upright, tilt your head to the side (lateral flexion) as far as you are able without straining or causing pain.  Do not elevate the shoulder while performing this test.  A Passing result is when the head tilts to the side without pain far enough so that the ear is almost touching the shoulder (over 45 degrees of lateral flexion, as shown).  A Not Passing result occurs when the head is unable to tilt at least 45 degrees or there is pain on lateral flexion.

TEST 3:  Scalene Palpation

As always, palpation (the medical term for pressing, feeling and squeezing to evaluate body tissue) is often the most effective test to identify myofascial trigger points in your Scalene muscle group.

The Scalenes can be palpated on the sides of the neck, in the space just in front of the bony vertebra and just behind the thick SCM muscle. Press two fingers into this space and feel for tender points and taut bands of muscle tissue.  Press gently to tolerance.  Start at the base of the neck near your collar bone and proceed up to just below the ear, as indicated by the green line.

Simple Self-Care Remedies

Here are simple self-care tips for relieving myofascial pain and dysfunction in your Scalenes:

Step 1:  Warming Up with Moist Heat

To relax and warm up the fibers of the Scalenes, take a warm bath or place moist heat such as a Fomentek bag over the front and sides of your neck for 10-15 minutes.
Step 2:  Compression

Click here to view larger imagePositioning your chosen self-care tool as shown, cover the entire length of the Scalenes, looking for taut bands and tender spots.  When you find a tender spot, press into the muscle to pain tolerance (“good pain” – not pain that is sharp or makes you want to withdraw).  Hold for 10 seconds while completing at least two full breaths in and out.  Then continue searching for more tender spots until the entire Scalenes muscle group is covered.

Step 3:  Stretching the ScalenesThe best stretch for the Scalenes is similar to the Lateral Flexion test we just performed above, only with 2 added steps.

Using a stretching strap or jump rope, step on one section of the rope and hold the other end with your hand so that the rope is taut (as Shown).  You should feel a gentle pull on your shoulder down toward the floor.

Now, tilt your head toward the opposite shoulder, as you did in the Lateral Flexion test.  Gently rest your opposite hand on the top of your head and stretch gently down toward the shoulder a little further.  Hold this stretch for 20 seconds to tolerance.  Repeat 3 times and alternate to the other side.

Perpetuating Factors:  One of the major perpetuating factors that causes trigger points to return in the Scalenes is improper breathing, which we will be covering in upcoming issues.  So keep up your reading … and your self-care, of course!