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Stiff, Swollen Hands in the Morning

Your Pain Pattern,
What Aggravates It,

The Underlying Anatomy
How to Get Relief,
and more…

How People Describe This Pain Pattern

People 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 the sensation between the shoulder blades and down the arm.

The patterns created by scalene muscles are varied. Some people just have pain in the upper back. Some people just have pain through the front of the shoulder. Some people only have pain in the upper back and chest.

When I was teaching neuromuscular technique, student were quick to say that the pattern was from the scalene muscles. It is important to look for supporting characteristics, like swollen hands, forward head posture or arms that “fall asleep” at night.

Make sure to look at other patterns in the posts about pain that extends from the torso into the arm. You might find something that is more specific with more effective self-care.

See how the pad of the index finger can touch the base of the finger while the first knuckle stays straight? This is an indicator that scalenes are not involved in thoracic outlet restriction and contribute to swollen hands.

This person is unable to touch the pad of the index finger to the base of the index finger while the fingers are held straight at the first knuckle. This stiffness is a strong indicator that scalenes are contributing to thoracic outlet dysfunction.

The Musculoskeletal Anatomy Behind Your Pain

Scalene muscles are complex guy wires that also lift the ribs during breathing. They have stuctural anomalies about 40% of the time.

You can read more about this in this post on scalene anatomy.

How You Activate and Intensify This Pain Pattern

The most common cases that I see for this involve people that sit with their shoulders forward so that it is difficult to breathe with their diaphragm. The scalenes go from being assistive breathing muscles to being the primary respiratory muscles as the lift the upper ribs and collarbone to inhale. The get overworked, displace the upper ribs and create chronic trigger point activity.

When they identify an activity, it usually involves an activity where they are seated with the arm in from of them as when they are driving with the arms at 10 & 2, working while slumped forward, rowing or activity that created heavy breathing.

Another common report is that their arms go to sleep when they sleep on their back. The scalene muscles choke the neurovascular bundle that runs to your arms.

These muscles get involved in assisting with heavy breathing as when sprinting or climbing stairs. People with this problem complain of tingling in their hands while huffing and puffing. This can also be a sign of thoracic outlet syndrome.

This pain pattern comes from the scalene muscles which assist in stabilizing the neck, moving the head side to side and breathing. you can read more about the anatomy in this post.

This is usually a part of Thoracic Outlet Syndrome. There is a better explaination of the related structures and a short video in this post.

Getting Relief on Your Own

Clinically Proven
Self-Care Recommendations.

This post has strategies for getting relief on your own. Explore how to change your activities, stretch and other strategies that relieve the pain associated with this trigger point.

Treatment Notes for Massage and Bodywork

Better Bodywork
Through Shared Expertise.

This post has techniques, tips, treatment routines, and anatomy illustrations to improve the bodyworker’s approach.

This site is undergoing changes. Starting in early 2020, we began improving the format. We are also adding more extensive self-care, illustrations, therapist notes, anatomy, and protocols. We appreciate your input and feedback. You will see us adding posts and updating older posts as time permits.

Weekly Featured Post

This post shows you how to press out the trigger points and stretch the infraspinatus muscle. It’s a small muscle on the back of the shoulder but creates a number of problems, including:

  • shoulder pain when sleeping
  • loss of grip strength
  • upper neck pain
  • pain along the inside edge of the shoulder blade

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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*This site is undergoing major changes. We are reformatting and expanding the posts to make it easier to read. The result will also be more accessible and
will include more patterns with better self-care. In the meanwhile, there may be inconsistency in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.


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