Muscle News Vol I.18:  Scalenes  
 
Rheumatoid Arthritis or Referred Pain?  Trigger Points Misdiagnosed Again!
Scalenes
This week, another great case of the success of myofascial trigger point therapy came to light!  We are fortunate to be able to share John's story of misdiagnosed Rheumatoid Arthritis in his hands that turned out to be trigger points in the Scalene Muscles of his neck - Thank you, John!

When John showed up for his appointment, he was just looking for a "tune-up" after leading a bicycle tour, something around a 60 mile distance.  Back when he started receiving trigger point therapy, it was after a long struggle with tendonitis-like pain in his hands. He had seen a doctor who told him told him he had Rheumatoid Arthritis and put him on self-injections of ENBREL.  Finally after seeing that this treatment wasn't going anywhere, John went to a specialist at a prominent hospital who was considered to be one of the best in the country.  This doctor ran some additional testing which revealed that John indeed DID NOT have Rheumatoid Arthritis.  He told John that what he had was Myofascial Pain.  Go Doc!  

However, Doc did not have a good referral for a myofascial therapist in his Rolodex, and sent John away with an antidepressant to look for a therapist who could treat myofascial pain.  Luckily, John was resourceful. He did some research on the internet, found a prominent myofascial trigger point therapist in his area... and that's when his recovery began.  

According to John, what surprised him the most was that the pain in his hands was actually referred pain from a muscle in his neck!  You might remember this muscle from a previous issue of Muscle News:  The Scalenes... also known as "The Entrappers", due to their ability to pinch nerves going down the arm.  

Here we have another great case of referred pain being misdiagnosed as arthritis, tendonitis, bursitis and other conditions.  Of course, there are certainly cases where those diagnoses are correct, but as in John's case, it might be worth evaluating and ruling out the myofascial component before putting someone on medications that might not be treating the real cause of the symptoms!  
Looking at the referred pain pattern in the picture above, it's easy to see how trigger points in the Scalenes could be misdiagnosed as problems in the shoulder, mid back, hand and wrist.  

So in honor of this magnificent muscle and in appreciation for John sharing his success story, let's review and evaluate our own Scalenes this week!

 
*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 Scalenes

The 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!

  
  
Sincerely,
  
Your Friends at The Pressure Positive Co.
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Link Highlights:

NAMTPT LOGO National Association  of Myofascial Trigger Point Therapists

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