Symptoms and Referred Pain from Myofascial Trigger Points in the Anterior Scalene Muscle or Scalenus Anterior

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1 Symptoms and Referred Pain from Myofascial Trigger Points in the Anterior Scalene Muscle or Scalenus Anterior picture Symptoms and signs Aching or throbbing in the lateral forearm extending to thumb and index finger Aching or throbbing pain in the neck Aching or throbbing pain in the posterior shoulder particularly along the border of the scapula Claudication in the upper limb

2 Coldness in the forearm Coldness in the hand Diffuse edema of the hand distal to the wrist over the bases of the four fingers and dorsum of the hand Dilatation of subcutaneous collateral subclavian veins over the chest Dilatation of subcutaneous collateral subclavian veins over the upper arm First rib joint dysfunction Hyperesthesia in the upper limb covering several dermatomes (like that seen in subluxation-induced fascilitation)

3 Hypoesthesia in the upper limb Lymphedema of the dorsum of the hand disappearing later in the day Lymphedema of the dorsum of the hand especially in the morning on awakening Mild cyanosis of the hands and fingers on the affected side Mild-to-moderate non-pitting edema of the hands and fingers on the affected side Numbness and tingling in the ulnar distribution in the hand (from entrapment of the lower trunk of the brachial plexus)

4 Numbness in the forearm and hand Numbness in the hand in the absence of no signs of neurological deficit on examination Numbness in the hand without signs of neurological deficit on examination reproduced by palpating the involved Trigger Point in the Anterior Scalene Muscle Pain at the upper medial border of the scapula Pain in the anterior aspect of the arm Pain in the anterior upper chest

5 Pain in the medial scapular border and adjacent interscapular region Pain in the posterior aspect of the arm Pain the lateral upper limb Painful sleeping Paresthesia in the upper limb Posterior shoulder pain, particularly along the border of the scapula Restricted ipsilateral rotation of the neck

6 Restricted lateral flexion of the neck Restriction of neck rotation Second rib joint dysfunction Shoulder pain a\w hemiplegia** Shoulder pain while rubbing the upper half of the arm Sleep propped up on pillows for relief throbbing pain in the neck* Pain Differential Diagnosis - Enrico Dellacà M.D Ph.D.

7 Sleep propped up on pillows for relief throbbing pain in the posterior shoulder * Sleep sitting up on a sofa due to night throbbing pain in the neck* Sleep sitting up on a sofa due to night throbbing pain in the posterior shoulder * Stiffness of the fingers especially in the morning on awakening Subclavian vein obstruction Tenderness of the Anterior Scalene Muscle to palpation Tightness of rings on fingers especially in the morning on awakening

8 Unexpected dropping of objects from the hand(from entrapment of the lower trunk of the brachial plexus) Upper back pain medially to the superior angle of the scapula Upper limb pain Weakness in the forearm and hand *According to Travell and Simons "this helps to prevent the sustained shortening of the scalene muscles that tends to occur when the patient lies flat and the chest and shoulders ride up around the neck during sleep" Travell and Simons

9 * *"Shoulder-girdle pain a\w hemiplegia is commonly due to myofascial TrPs in the Trapezius Muscle, Supraspinatus Muscle, Iinfraspinatus Muscle, Subscapularis Muscle and Scalene muscles" Travell and Simons Referral area \ Referred pain from myofascial trigger points (TrPs) in the anterior scalene muscle Pain referred over the anterior region of the shoulder Pain referred over the anterior region of upper chest Pain referred over the anterior region of upper arm Pain referred to the medial border of the scapula

10 Pain referred down the posterior and lateral sides of the arm to the thumb and index finger. Pain referred over the anterior region of the forearm (radial side) until the thumb and the index finger Pain referred anteriorly to the chest, posteriorly to the medial scapular border and adjacent interscapular region, laterally to the upper limb Pain referred to the upper back just over the upper half of the vertebral border of the scapula and to the adjacent interscapular region Shoulder pain extending down over the biceps area in anterior aspect of arm and triceps area in posterior aspect of the arm Pain extending down over the biceps area skipping the elbow and reappearing in the radial side of the forearm, the thumb and the index finger

11 Pain extending down over the triceps area skipping the elbow and reappearing in the radial side of the forearm, the thumb and the index finger Upper limb pain produced severe phantom limb pain in amputated arm Severe tension headache Pain in the anterior upper chest referred in two finger-like projections over the pectoral region down to the nipple level

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