This is part of a series on the causes of arm and hand pain. To see the general list, go back to the checklist of causes.

The scalene muscles have two important contributions to arm and hand pain. First is that the scaleni are the first point of entrapment for the nerves and blood vessels that serve the arm, an area called the thoracic outlet of which the scaleni are the first part. The second contribution is that this little set of 4 muscles have major Trigger Point referrals to the arm and hand. (scaleni [say sk-ahh-lay-nee] in Latin is the plural of scalenus used to name the 4 muscles of this group)

You’ve probably heard of thoracic outlet syndrome, a description of symptoms occurring when blood and nerve supply to the upper extremity is compromised. Symptoms vary, but usually include tingling and numbness and various degrees of pain depending on the degree of neurovascular entrapment or nerve compression. One of the obvious signs is numbness, especially with the arm raised above the shoulder. When nerves are entrapped, there is loss of sensation and muscle function.

When blood vessels are trapped (vascular entrapment), pain can occur. Think of a heart attack. There is local and referred pain. Cells can’t live without blood because it carries the oxygen and nutrients necessary for health and removes waste products that cause irritation and pain. There are severe warning signs from the body when blood is lacking because it is necessary for life!

The Trigger Points from these little muscles are major in comparison to their size. They are almost always part of the pain puzzle that needs to be solved when thinking about the causes of arm and hand pain. Treatment involves manual treatment, specific stretches for the neck and shoulder and deep breathing.

In my Neuromuscular Therapy center near Boston, arm and hand pain is treated every week using manual techniques. We also instruct patients in corrective stretches and positional changes that affect the muscles of the neck and anterior shoulder.