Therapist Notes – Subclavius

Paget-Schroetter syndrome is a specific form of thoracic outlet syndrome where the subclavian artery moves medially until it is restricted with pressure from the subclavius muscle. The arm becomes chronically swollen and bluish. It is more common among athletes that weight lift or play tennis.

In one case, I noticed that a woman’s arm was swollen a bluish.  The arm turned bright red, and the swelling went down when I released the subclavius and pecs, and lifted the collar-bone. Her arm was swollen and bluish again the next morning. I referred her out immediately, and she was able to verify the structural anomaly and restricted vein with ultrasound. She resolved the problem by having a section of her rib surgically cut out to provide room for the vein.

This post on Thoracic Outlet Syndrome has a video and document detailing the structures including the layout of the subclavian vein.

Subclavius seldom presents as the primary problem but generates intense sensation under static pressure when the trigger point is active. It is easily overlooked but can be a critical piece in resolving thoracic outlet problems. It not only pulls the rib down on the neurovascular bundle but can occlude the bundle, especially the subclavian vein, when it becomes stiff and hypertrophied.

Subclavius is covered by clavicular pectoralis major and can be tedious to work. Mobilizing fixations in the sternoclavicular joint will reduce proprioceptive feedback that perpetuates trigger points in the subclavius.

This post has the is the Anterior Thorax Supine routine from The Workbook of Classical Neuromuscular Therapy.

Treatment of the subclavius muscle shown in the featured image of the post.

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Tony Preston has a practice in Atlanta, Georgia where he sees clients. He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.

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