Dominic Stone
The scalene muscles are a group of three muscles on each side of the neck, identified as the anterior, middle, and posterior. The name 'scalene' comes from the Ancient Greek word 'skalēnós', meaning 'uneven', as the pairs are all of differing lengths. The scalenes act as accessory muscles of respiration and perform flexion, lateral flexion, and rotation of the neck. They are also involved in certain forms of thoracic outlet syndrome, which can cause myofascial pain syndrome and other symptoms that mimic a spinal disc herniation.
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What You'll Learn
The three scalene muscles
The scalene muscles are a group of three muscles on each side of the neck, identified as the scalenus anterior, the scalenus medius, and the scalenus posterior. They are also known as the anterior, middle, and posterior scalene muscles. The name 'scalene' comes from the Ancient Greek 'σκαληνός' or 'skalēnós', meaning 'uneven', as the pairs of muscles are all of differing lengths.
The scalenus anterior is the foremost of the three scalene muscles. It originates from the anterior tubercles of the transverse processes of the cervical vertebrae C3-C6 and attaches to the scalene tubercle on the inner border of the first rib. This muscle forms the anterior border of the interscalene triangle, with the posterior border formed by the scalenus medius and the inferior border formed by the first rib. The scalenus anterior acts on the joints between the cervical vertebrae and is involved in flexion of the neck. It is also related to many structures of the neck, including the suprapleural membrane, pleura, roots of the brachial plexus, and the subclavian artery.
The scalenus medius is the largest and longest of the three scalene muscles. It arises from the posterior tubercles of the transverse processes of the cervical vertebrae C2-C7 and inserts into the upper surface of the first rib. This muscle forms the posterior border of the interscalene triangle. The brachial plexus and subclavian artery pass anterior to the scalenus medius.
The scalenus posterior is the smallest and most deeply seated of the three scalene muscles. It arises by two or three separate tendons from the posterior tubercles of the transverse processes of the cervical vertebrae C5-C7 and inserts into the outer surface of the second rib. It is supplied by cervical nerves C5, C6, and C7. The scalenus posterior is the target muscle when performing a nerve block, or interscalene block, prior to arm or shoulder surgery.
The scalene muscles collectively act to elevate the first and second ribs, increasing intrathoracic volume and aiding in respiration. They also perform flexion, lateral flexion, and rotation of the neck.
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Their location in the neck
The scalene muscles are a group of three muscles on each side of the neck, identified as the anterior, middle, and posterior. They are named scalene, from the Ancient Greek 'skalēnós', meaning 'uneven', as the pairs are all of differing lengths.
The scalene muscles are located beneath the prevertebral fascia within the floor of the posterior triangle of the neck. They are attached at one end to bony protrusions on vertebrae C2 to C7 and at the other end to the first and second ribs. The anterior scalene muscle (scalenus anterior) lies deeply at the side of the neck, behind the sternocleidomastoid muscle. It originates from the anterior tubercles of the transverse processes of the third, fourth, fifth, and sixth cervical vertebrae. The middle scalene (scalenus medius) is the largest and longest of the three scalene muscles. It arises from the posterior tubercles of the transverse processes of the lower six cervical vertebrae. The posterior scalene (scalenus posterior) is the smallest and most deeply seated of the scalene muscles. It arises by two or three separate tendons from the posterior tubercles of the transverse processes of the fourth, fifth, and sixth cervical vertebrae.
The scalene muscles have an important relationship with other structures in the neck. The brachial plexus and subclavian artery pass between the anterior and middle scalenes. The subclavian vein and phrenic nerve pass anteriorly to the anterior scalene as the muscle crosses over the first rib. The phrenic nerve is oriented vertically as it passes in front of the anterior scalene, while the subclavian vein is oriented horizontally. The scalene muscles are active during inspiration and, when the cervical spine is stabilised, they can elevate the first two ribs to act as accessory muscles of respiration.
The scalene muscles can be targeted with specific stretches and exercises to relieve tension and trigger points. For example, to target the posterior scalene, turn your face toward the arm that is pulling. To target the anterior scalene, turn your face away from the pulling arm. To target the middle scalene, look straight up at the ceiling or slightly toward the pulling arm.
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Their function and use in respiration
The scalene muscles are a group of three muscles on each side of the neck, namely the scalenus anterior (anterior scalene), scalenus medius (middle scalene), and scalenus posterior (posterior scalene). The name 'scalene' comes from the Ancient Greek 'skalēnós', meaning 'uneven', as the muscles are of differing lengths.
The scalenes act as accessory muscles of respiration, performing flexion at the neck and elevating the first and second ribs, thereby increasing the intrathoracic volume. They are not required in the respiration of a healthy individual, and so their use is an important clinical sign of respiratory distress.
The scalenus anterior is the foremost of the three scalene muscles. It originates from the anterior tubercles of the transverse processes of the vertebrae C3-C6 and attaches to the scalene tubercle on the inner border of the first rib. This muscle elevates the first rib and, when combined with the contraction of the external intercostal muscles, expands the antero-posterior diameter of the thorax.
The scalenus medius is the largest and longest of the three scalene muscles. It arises from the transverse processes of the cervical vertebrae C2-C7 and inserts into the superior border of the first rib. The contraction of this muscle produces strong ipsilateral flexion of the neck and helps to stabilise or raise the first rib during respiration.
The scalenus posterior is the smallest and deepest of the three scalene muscles. It arises from the posterior tubercles of the transverse processes of cervical vertebrae C5-C7 and inserts into the external surface of the second rib. This muscle elevates the second rib and tilts the neck to the same side.
The scalenes, along with the sternomastoids, are two prominent inspiratory muscles of the neck. Studies have shown that inflation induces greater shortening of the scalenes than the sternomastoids.
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Their innervation
The scalene muscles are a group of three muscles on each side of the neck, identified as the anterior, middle, and posterior. They are also known as the scalenus anterior, scalenus medius, and scalenus posterior, respectively. These muscles are responsible for flexion, lateral flexion, and rotation of the neck, as well as elevating the ribs during forced inspiration.
The scalene muscles are innervated by the third to the eighth cervical spinal nerves (C3-C8). Each of the three muscles has a distinct innervation:
- Scalenus Anterior: Innervated by the anterior rami of cervical spinal nerves C3-C6. It acts on the joints between the cervical vertebrae and can produce flexion of the neck, depending on the position of the head and type of muscle contraction.
- Scalenus Medius: Receives its innervation from the anterior rami of cervical spinal nerves C3-C8. Contraction of this muscle results in strong ipsilateral flexion of the neck and helps stabilize or raise the first rib during respiration.
- Scalenus Posterior: Innervated by the anterior rami of spinal nerves C6-C8. When the costal attachment is fixed, unilateral contraction of this muscle leads to ipsilateral lateral flexion of the neck. It also helps stabilize or elevate the second rib during respiration.
The scalene muscles have an important relationship with other structures in the neck. The brachial plexus and subclavian artery pass through the space between the anterior and middle scalene muscles, forming the scalene hiatus or scalene fissure. This region is clinically significant, as it is sometimes targeted for regional anesthesia before arm or shoulder surgery.
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Clinical correlations and associated pain
The scalene muscles are a group of three paired muscles in the neck: the scalenus anterior, scalenus medius, and scalenus posterior. Sometimes, a fourth muscle, the scalenus minimus, is also present. These muscles are involved in flexion, lateral flexion, and rotation of the neck, as well as respiration.
Scalene muscles are the most prevalent muscles related to neck pain. When the scalene muscles become very tight, they can trigger pain in the head, jaw, cheek, and behind and above the eye. Tight scalene muscles can also lead to tension headaches and can pull the first rib upwards. Poor breathing habits, such as chest breathing, can cause serious strain on the scalene muscles, resulting in a scalene strain. Strained scalene muscles can also intensify coughing during a common cold or allergies, as these muscles are engaged when lifting the ribs during coughing.
Certain activities and lifestyle factors can contribute to scalene muscle pain. These include:
- Whiplash injuries
- Excessive coughing
- Gasping for air, which is more common in individuals with asthma, emphysema, bronchitis, or pneumonia
- Pulling or lifting with arms at waist level
- Working with the head turned to one side for extended periods
- Sleeping on the stomach with the head turned to one side
- Carrying a heavy backpack or purse
- Wearing a tight collar or tie
To alleviate pain and discomfort associated with scalene muscles, various treatments can be employed:
- Trigger point therapy: Chiropractors may use direct pressure or ischemic compression to release tension and deactivate trigger points in the scalene muscles.
- Myofascial release techniques: Gentle stretching and manual manipulation of the soft tissues can improve circulation, reduce inflammation, and enhance tissue mobility.
- Heat or cold therapy: Applying heat or cold can help relax muscles, reduce inflammation, and alleviate pain.
- Lifestyle modifications: Addressing stress management, dietary habits, and sleep hygiene can improve musculoskeletal health and reduce pain.
- Soft tissue massage: This technique relieves tension in the musculature and increases joint stability.
- Self-stretching exercises: Specific stretches can help decrease scalene muscle pain and tension.
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Frequently asked questions
Scalene muscles are a group of three muscles on each side of the neck, identified as the anterior, middle, and posterior. They are named after the Ancient Greek word 'skalēnós', meaning 'uneven' as the pairs are all of differing lengths.
The main functions of the scalene muscles are flexion, lateral flexion, and rotation of the neck. They are also accessory muscles of respiration, elevating the ribs during forced inspiration.
The scalene muscles are attached at one end to bony protrusions on vertebrae C2 to C7 and at the other end to the first and second ribs.
Trigger points in the scalene muscles can cause chest pain and breathing difficulties. They may also be involved in certain forms of thoracic outlet syndrome and myofascial pain syndrome.
Lie supine with your head elevated and rotated to the side. Gently pull your head and neck so that your ear is tilted towards your shoulder. To target a specific scalene muscle, rotate your head accordingly.
