Muscles of Upper Thorax Pain and Shoulder Arm Pain

■ Levator Scapulae Muscle (Figs. 19.25.19.26)

Origin

Posterior tubercle C1-C4

Insertion

Medial border of the scapula (cranial)

Action

• Rotation of the caudal scapular angle to medial, and elevation of the cranial scapular angle to cranial-medial

• Extension (double-sided contraction) and ipsilateral rotation of the CSC

Innervation

Dorsal scapular nerve (C5) and ventral branches of the spinal nerves C3-C4

Trigger Point Location

TP1 Shoulder-neck transition, palpable when trapezius is displaced to posterior TP2 Ca. 1.3 cm above the upper scapular angle

Referred Pain

• Transition from the shoulder to the neck

• Medial scapular border

• Dorsal shoulder region

Associated Internal Organs

• Gallbladder

Levator scapulae

Rhomboid minor

Rhomboid major

Major Muscles The Arm

Supraspinal Infra spinatus Teres

Teres major minor

Levator scapulae

Rhomboid minor

Rhomboid major

Supraspinal Infra spinatus Teres

Teres major minor

TP Teres minor

Teres ^ major

Infraspinatus Pain

Infraspinatus

Teres major

Latissimus dorsi b

Collarbone Shoulder blade ridge Deltoid, posterior section

Supraspinatus

Teres minor

TP Teres minor

Infraspinatus

Teres major

Latissimus dorsi b

Teres ^ major

Collarbone Shoulder blade ridge Deltoid, posterior section

Supraspinatus

Teres minor

Levator scapulae

Rhomboid minor

Rhomboid major

Teres Major Pain

Teres major

Levator scapulae

Rhomboid minor

Rhomboid major

Supraspinatus Infraspinatus Teres minor

Teres major

Levator scapulae

Rhomboid minor

Rhomboid major

Infraspinatus Pain

Teres major TP of the infraspinatus minor

Teres major TP of the infraspinatus

Levator scapulae

Rhomboid minor

Rhomboid major

TP of the supraspinatus Supraspinatus Infraspinatus Teres minor

Scalene Muscles (Figs. 19.27,19.28,19.29) Origin

• Scalenus anterior: anterior tubercles C3-C6

• Scalenus medius: posterior tubercles C2-C7

• Scalenus posterior: posterior tubercles C4-C6

• Scalenus minimus: anterior tubercle C7

Trigger Point Location

The scalene muscles are found in the fossa supraclaviculars major and are partly compressed against the transverse processes of the cervical vertebrae. The trigger points are distributed in the muscles at varying heights.

Insertion

• Scalenus anterior: scalene tubercle of the first rib

• Scalenus medius: upper edge of the first rib (near neck of rib)

• Scalenus posterior: lateral posterior outside of the second rib

• Scalenus minimus: suprapleural membrane

Referred Pain

• Radial ventral and dorsal upper arm and forearm

Action

• Inhalatory muscles

• Scalenus anterior: additionally supports the lateral flexion of the CSC when the rib is fixed

• Scalenus minimus: tenses the pleural dome

Innervation

Ventral branches of the spinal nerves:

• Scalenus anterior: C5-C6

• Scalenus posterior: C6-C8

• Scalenus minimus: C7

Scalenus ma^ii ar

Examples of TPs

Longus capitis

Referred Pain

capitis anterior

Longus colli

Spinal column

Ribs capitis anterior

Longus colli

Spinal column

Ribs

Scalenus ma^ii ar

Examples of TPs

Rectus capitis lateralis 1st cervical vertebra

Longus capitis

Referred Pain

Fig. 19.29

Fig. 19.28

Fig. 19.29

Thumb and index finger from dorsal (scalenus minimus: entire back of the hand) Medial border of the scapula

Associated Internal Organs

See teres major muscle.

This referred pain can be confused with the pain pattern of a heart attack!

Supraspinatus Muscle (Figs. 19.30,19.31) Origin

• Supraspinous fossa of the scapula

• Spine of the scapula

Insertion

• Greater tubercle of the humerus (proximal facet)

• Shoulder joint capsule

Action

• Abduction of the arm

• Shoulder joint stabilizer

Trigger Point Location

Both trigger points are easily palpable in the supraspinous fossa of the scapula.

Referred Pain

• Lateral deltoid area

• Lateral epicondyle

• Lateral upper arm and forearm

• Shoulder roof

Associated Internal Organs

Innervation

Suprascapular nerve (C5-C6)

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