Trigger Points – Stiff, Swollen Hands in the Morning

Client’s Description

referral - scalene - posterior1People complain about awakening with stiff and swollen hands. Some of them have problems with tingling and sleeping hands in the night. They often get up and move their arms around until the tingling stops, and the arms are awake again. Sometimes, they have pain or tingling when they hold their arms near shoulder level as when driving, putting on make-up or cutting hair.

The pattern does not usually occur in full as illustrated but as part of that pattern. As the illustration indicates, the pain. Tingling and “numbing” is most likely to occur in the areas of darkest red. When there are stiff, swollen hands, the sensations around the index finger and thumb are a greater focus, although the tension behind the shoulder is often there. If I press into the muscle at the base of the neck, the client almost always describes sensation between the shoulder blades and down the arm.

When you awake with stiff, swollen hands, try this standard test for scalenes. Try to bend your second and third knuckle so that your fingertips touch the base of your fingers while holding the first knuckle straight. If you can’t do this, scalenes are indicated as the problem.

scalenes test back scalenes good front
Good, scalenes are not indicated as a problem.

Problem - can't close fingers
Not Good, scalenes are indicated as a problem.

Self Care

Stiff and swollen hands are usually a problem when the client sleeps on their back (as is often recommended) with their arms by their side. Some people avoid this problem, as well as “numbing arms and hands” by sleeping on their side or stomach. Don’t rely on that in the long term.

Also, if you awaken with numb arms that are difficult to move, try shrugging your shoulders in a circular motion. This movement usually restores neurovascular flow the arms without the awkwardness of trying to get out of bed or roll around without using your arm(s).
There are some stretches and exercises that are helpful for tight scalene muscles. Look how they are ideally placed so that they pull up on the rib and cinch around the nerves and blood vessels when you use them to breathe.

First, look at this post on breathing exercises, it is useful for both retraining your breathing pattern and loosening rib heads that are fixated.

ice_and_stretch_position_6Secondly, there are some standard stretches for releasing tension on scalene muscles. I’ll be posting something about that routine, but the stretch in this post  helps. If you already know ice and stretch, click on this gif to see the stretch.

Most research agrees that long-term relief is based on correcting Forward Head Posture. It is also clear that the first rib and second rib are usually elevated, and some direct work to resolve that is needed for long-term results. Your trigger point specialist is trained to assess and correct that.

Therapy Notes

Scalene muscles look like guy wires on the side of the neck but are more like the ropes that support hoops that go around a column. When the rib head gets elevated, it is challenging to get lasting relief.

Most neuromuscular therapists release the rib head with static pressure on the attachment of the muscle to the rib. This mobilization should be early in the treatment so that the trigger points will release if the muscle bellies are worked directly.

Scalenes are a focal point of treatment for many reasons. The increase in head-forward postures creates shearing at the base of the neck and treatment of scalenes help with correcting that problem.

Here is a paper on Thoracic Outlet Structures to help better understand this syndrome.

Similar Patterns

Click on these categories to see if there is a referral pattern that better describes your concerns.

Scalenes overlap most areas in the upper torso and upper extremity. Here are the most common areas where people complain of scalene referral:

 tags-torso-into-arm tags-hand tags-upper-back tags-chest  

referrals - scalenes - anteriorWhen scalene muscles refer to both the front and back of the thorax as well as down the arm, it produces chest pain with sensations up and down the arm. It is similar to the sensations created by a heart attack. If these symptoms arise, it is imperative to see a doctor first to rule out a cardiac problem. I have seen clients that have these symptoms but have been cleared by their doctor beforehand. The received relief from symptoms when the scalenes were treated.line - black


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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The Body
(404) 226-1363


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