Your Pain Pattern,
What Aggravates It,
The Underlying Anatomy
How to Get Relief,
How People Describe This Pain Pattern
People complain about waking in the morning 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 when driving, putting on makeup, 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” are most likely to occur in the darkest red areas. When there are stiff, swollen hands, the index finger and thumb’s sensations 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 vary. 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, students 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 the pain that extends from the torso into the arm. You might find something more specific with more effective self-care.
See how the index finger’s pad (and other finger pads) 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. It is more than just the index finger. It can be stiffness and restriction in any, and usually all of the fingers. This 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 they lift the upper ribs and collarbone to inhale. They 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 hands up in front of them. This might be when they are driving with the arms at 10 & 2, or working while slumped forward, or rowing, or activity that created heavy breathing.
Another common report is that their arms go to sleep when they sleep on their back. Tight scalene muscles choke the neurovascular bundle that runs to your arms.
These muscles also 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.
Getting Relief on Your Own
Scalene muscles produce stiff swollen hands and other patterns in the torso and upper extremity. 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.
Therapy Notes for Massage and Bodywork
Through Shared Expertise
This post has techniques, tips, treatment routines, and anatomy illustrations to improve the bodyworker’s approach.
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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.
*This site is undergoing significant changes. We are reformatting and expanding the posts to make them 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 inconsistencies in formatting, content presentation, and readability. Until we get older posts updated, please excuse our mess.