People seldom have any part of this pattern as their primary complaint, but when they do, it is usually biceps pain. When this is a problem, the entire pattern can usually be elicited by pressing up under the collar-bone near the sternum. This response is surprising and intense for a pattern that is seldom a part of the primary complaint. I usually find this trigger point by working the area based on other complaints related to pecs or thoracic outlet syndrome.
A small percentage of people complain about pain along the collar-bone. They trace the pattern along the collar-bone just as shown in the illustration. If subclavius has pulled the collar-bone down onto the subclavian vein, there may be swelling and bluish color in the arm.
Other trigger points more frequently cause the parts of this pattern, so this muscle is easy to overlook until those patterns have been eliminated.
This is a small muscle among many larger ones. This often means that it screams at the far end of motions or when the arm is jerked.
When I elicit the pattern, which is usually surprisingly intense, the client almost always recalls a forceful movement down and forward with the arm. These have included, tennis forehand with backspin, chopping with an ax or mattock, boot camp exercises, and trying to unstick a door. One woman aggravated it by pushing veggies into her juicer. People have also complained about this pattern when the mouse or keyboard is too far away and they have to reach while working on the computer.
Subclavius is a small muscle on the bottom of the collarbone. You can read more about the anatomy in this post about subclavius.
Paget-Schroetter syndrome is a specific form of thoracic outlet syndrome where the subclavian artery moves medially until it is restricted and 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 the 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.
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.
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 materials and instructed classes since the mid-90s. This includes anatomy, trigger points, cranial, and neuromuscular.
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