Muscles of Upper Torso Pain

■ Pectoralis Major Muscle (Fig. 19.70)

Origin

• Clavicular part:

- clavicle (sternal half)

• Sternocostal part:

- lateral at the manubrium and body of the sternum

- rib cartilage 1-6

- aponeurosis of the abdominal external oblique muscle

Insertion

• Crest of the lesser tubercle of the humerus

• Deltoid tuberosity (ventral)

Action

• Clavicular part: flexion, adduction in the shoulder joint

• Sternocostal part: adduction and internal rotation in the shoulder joint, inhalatory muscle

Innervation

Trigger Point Location

Trigger points are distributed throughout the entire muscle. The points that are located more laterally and closer to the armpit are easily found by pinching palpation. The more sternally located points are detected by shallow palpation.

Trigger point of "arrhythmia": In the center between two vertical lines, of which one runs through the nipple and the other through the lateral border of the sternum, look for the trigger point in the intercostal space between the fifth and sixth rib on the right side.

Referred Pain

Trigger points of the clavicular part:

• Ventral deltoid area

• Clavicular part itself

Trigger points of the sternocostal part, lateral:

• Ventral chest area

• On the inside of the upper arm

• Medial epicondyle

• Ventral forearm

• Palmar hand surface of fingers 3-5

Sternocostal Pain
Fig. 19.70a-d

Trigger points of the sternocostal part, medial:

• Sternum (without crossing over the center line) and bordering chest area

Trigger points of the sternocostal part, caudal:

• Ventral chest area with hypersensitivity in the nipple and possibly in the entire chest (especially in women)

Trigger points of "arrhythmia":

■ This trigger point occurs in cardial arrhythmia without causing pain.

Associated Internal Organs

Heart

■ Pectoralis Minor Muscle (Fig. 19.71)

Origin

Third to fifth rib Insertion

Coronoid process of the scapula (cranial-medial) Action

• Pulls the scapula forward and downward

• Inhalatory muscle when shoulder blade is fixed

Innervation

Medial and lateral pectoral nerves (C6-C8) Trigger Point Location

TP1 Near the origin of the muscle at the fourth rib TP2 At the transition from the muscle belly to the tendon slightly caudal from the coronoid process of the scapula

Referred Pain

• Ventral deltoid area

• Ulnar side of the upper arm, elbow, forearm

• Palmar hand surface of fingers 3-5

The referred pain pattern closely resembles that of the pectoralis major.

Associated Internal Organs f

Middle Finger Trigger Points

Fig. 19.71

Heart

■ Subclavius Muscle (Figs. 19.72.19.73) Origin

First rib (cartilage-bone border) Insertion

Clavicle in the middle third on the underside Action

Pulls the clavicle downward Innervation

Subclavian nerve (C5-C6)

Trigger Point Location

Near the insertion of the muscle

Referred Pain

• Ventral area of the shoulder and upper arm

• Radial side of the forearm

• Palmar and dorsal hand surface in the area of fingers 1-3

Associated Internal Organs

The subclavius is frequently innervated by a branch of the phrenic nerve. This leads to connections with the:

• Gallbladder

TP of the subdavius - projected onto the pectoralis major

Clavicle

Deltoid, clavicular part

Pectoralis Major Dorsal Deltoid

«-TPs of the pectoralis major

Coraco-brachialis

Pectoralis major Pectoralis minor

TP "heart" of the pectoralis major

«-TPs of the pectoralis major

Coraco-brachialis

TP of the subdavius - projected onto the pectoralis major

TP2 TP1 Pectoralis minor

Deltoid, acromial part

Pectoralis major Pectoralis minor

TP "heart" of the pectoralis major

Clavicle

Deltoid, clavicular part

Fig. 19.72

Reffered Pain

Only found in one out of 20 people. Origin

Unilaterally or bilaterally in the pectoral fascia or the fascia of the SCM with possible origins in the cranial sternum area

Insertion

Great variability with possible insertions between the third to seventh rib cartilage, pectoral fascia, or the fascia of the rectus abdominis

Action

Unknown, possibly fascia stretcher Innervation

Medial pectoral nerve (C6-C8) or intercostal nerves Trigger Point Location

Trigger points can be found in the entire muscle belly, mostly in the central area of the sternum.

Referred Pain

Entire sternum, possibly also substernal • Upper chest area Ventral upper arm and elbow

The referred pain pattern resembles the pain of a heart attack or angina pectoris.

Associated Internal Organs

Heart

Vertebrae Arm Pain
Fig. 19.74

Serratus Posterior Superior Muscle (Figs. Origin

Spinous process and supraspinous ligaments of C7-T2 Insertion

Outside of ribs 2-5 (posterior) Action

Inhalatory muscle in deep inhalation Innervation

Ventral branches of the spinal nerves T2-T5 Trigger Point Location

In neutral position, the trigger point projects itself at the height of the supraspinatous scapular fossa near the scapular spine onto the dorsal wall of the torso.

19.75, 19.76) Referred Pain

• Underneath the scapula in its upper half

• Dorsal deltoid area

• Dorsal upper arm

• Ulnar side of the forearm

• Ventral and dorsal surface of the hand in the area of the hypothenar eminence and finger 5

• Pectoral area

Associated Internal Organs

TP of the serratus posterior superior

Inferior Scapula Muscle PainSerratus Posterior Inferior Muscle Pain
Fig. 19.76

TP of the serratus posterior superior

Serratus Posterior Inferior Muscle (Fig. 19.77) Origin Trigger Point Location

Spinous process and supraspinous ligaments of T11- In the muscle belly near the insertion to the ribs (see L2

Insertion

Outside of ribs 9-12 (posterior) Action

Exhalatory muscle in deep exhalation Innervation

Ventral branches of the spinal nerves T9-T12

Fig. 19.75) Referred Pain

In the area of the muscle around the lower ribs

Associated Internal Organs

Kidneys Duodenum

• Pancreas Jejunum, ilium

Nuchal fascia

Sternodeido-mastoideus

Trapezius

Thoracolumbar Fascia Pain

Autochthonous back muscles with thoracolumbar fascia

- Serratus posterior inferior

TP of theserratus posterior inferior

- Gluteus maximus

Rhomboideus minor

- Originating aponeurosis of the latissimus dorsi

Nuchal fascia

Sternodeido-mastoideus

Rhomboideus major

TP of theserratus posterior superior

— Serratus posterior superior

Thorax with intercostal muscles

Autochthonous back muscles with thoracolumbar fascia

- Serratus posterior inferior

TP of theserratus posterior inferior

- Gluteus maximus

Trapezius

Rhomboideus minor

- Originating aponeurosis of the latissimus dorsi

- External abdominal oblique muscle - Iliac crest

- Gluteus medius

Thoracolumbar fascia and tendon of origin of the latissimus dorsi

Fig. 19.78

Intercostal Muscle Pain

Fig. 19.78

Fig. 19.77

■ Serratus Anterior Muscle

Ribs 1-9 and intercostal spaces in the area of the medioclavicular line

Insertion

Medial border of the scapula

Shoulder blade

Serratus Anterior Pain Locations
Serratus anterior, lower part

Shoulder blade

Serratus anterior ipper part

Serratus anterior, horizontal part

Intercostal Muscle Pain

Action

• Pulls the scapula to ventrolateral

• Accessory muscle of inhalation

Innervation

• Long thoracic nerve (C5-C7) ■ Intercostal nerves

Trigger Point Location

In the muscle shaft that originates at the fifth or sixth rib, near the middle axillary line

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Fig. 19.81

Fig. 19.80 Referred Pain

• Anterolateral in the central chest area

• Medial from the lower scapula angle

• Medial upper and forearm

• Hand surface with fingers 4 and 5

Deepened breathing, such as during sports, can cause pain like stitches in the side

Associated Internal Organs

Heart

■ Erector Spinae Muscles (Figs. 19.82.19.83,19.84)

Iliocostal Muscle Origin

• Spinous processes of the lumbar spinal column (LSC)

• Thoracolumbar fascia

Insertion

Cranial and caudal at the transverse processes of the middle CSC or rib angles for the lumbar and thoracic area

Action

• Lateral flexion of the spinal column

• Extension of the spinal column

Innervation

Dorsal branches of the segmental spinal nerves

Segmentale Innervation
Fig. 19.83

Longissimus Muscle Origin

• Transverse processes

• Spinous and mammillary processes of the LSC Insertion

• Transverse processes that are located cranial from the origin

• Mastoid process

• Costal and accessory process of ribs 2-12 Action

Extension of the spinal column Innervation

Dorsal branches of the segmental spinal nerves

Spinalis Muscle Origin

Spinous processes of the spinal column Insertion

Segmentale Innervation
Fig. 19.84

Action

Spinous processes of the six vertebrae that lie cranial Lateral flexion of the spinal column to the origin

Innervation

Dorsal branches of the segmental spinal nerves Trigger Point Location

Trigger points can be distributed all throughout the erector spinae muscles. It is helpful in finding the trigger points that the spinous processes may be hypersensitive at the height where the erector spinae trigger points are active.

Referred Pain

Trigger points in the iliocostalis, central thorax area: To cranial into the shoulder area and into the lateral chest wall.

Trigger points in the iliocostalis, lower thorax area: To cranial above the scapula, forward into the abdomen and into the upper LSC.

• Trigger points in the iliocostalis, lumbar section: To caudal in the central buttocks area.

• Trigger points in the longissimus: Into the gluteal area and the iliosacral joint (ISJ) region.

• Trigger points in the spinalis: The pain is concentrated around the trigger point.

Associated Internal Organs

• Urinary bladder

Rectus Abdominis, Abdominal Internal and External Oblique, Transversus Abdominis, and Pyramidalis Muscles (Figs. 19.85,19.86,19.87,19.88)

Rectus Abdominis Muscle Action

Origin

• Pubic symphysis

• Sidebend of the torso

• Rotation of the torso to the ipsilateral side (together with the contralateral muscle)

Insertion

• Fifth to seventh rib cartilage

• Xyphoid process, backside

Action

• Torso flexion

• Abdominal press Forced exhalation

Innervation

Ventral branches of the spinal nerves T7-T12

Abdominal Internal Oblique Muscle Origin

• Thoracolumbar fascia

• Frontal two-thirds of the iliac crest

• Lateral two-thirds of the inguinal ligament

Insertion

Anterior and posterior lamina of the rectus sheath

• Tendinous to the pubic crest and pectineal line

Abdominal External Oblique Muscle Pain
Fig. 19.85
Muscles Chains
Fig. 19.87

• Abdominal press

• Forced exhalation

• Reinforcement of the inguinal canal

Innervation

Ventral branches of the spinal nerves T7-T12

Muscles Chains

Abdominal External Oblique Muscle Origin

Ventral outside of ribs 5-12

Insertion

• Inguinal ligament

• Pubic tubercle

Action

• Sidebend of the torso

• Rotation of the torso to the contralateral side (together with contralateral muscle)

• Abdominal press

• Forced exhalation

Innervation

Ventral branches of the spinal nerves T7-T12

Transversus Abdominis Muscle Origin

• Inside of the lower ribs

• Thoracolumbar fascia

• Frontal two-thirds of the iliac crest

• Outer half of the inguinal ligament

Insertion

• Anterior and posterior lamina of the rectus sheath

Action

• Abdominal press

• Forced exhalation

• Reinforcement of the inguinal canal

Innervation

Ventral branches of the spinal nerves T7-T12

Pyramidalis Muscle Origin

Pubic crest, ventral from the insertion of the rectus abdominis

Insertion

Linea alba, distal

Action

Reinforcement of the rectus sheath

Innervation

Subcostal nerve (T12)

Abdominal Muscles Trigger Point Location

We find trigger points distributed throughout the entire abdominal musculature. Figs. 19.85-19.88 demonstrate a selection of common trigger point localizations.

Referred Pain

In general, we can state that a majority of trigger points in the abdominal muscles have in common that they generate mostly localized pain around the trigger point. In addition, trigger points in the abdominal muscles cause a number of visceral symptoms, such as nausea, vomiting, or dysmenorrhea. A further special characteristic of trigger points in the abdominal musclesis that the referred pain crosses over the center line. Nevertheless, we can define a few typical pain patterns for the abdominal muscles:

Trigger points for the extermis abdominis, rib section:

• Symptoms resembling a hiatal hernia

External Obliques Referred Pain
Fig. 19.88

• Epigastric pain that extends to other abdominal regions

Trigger points of the lower abdominal wall (all muscles of the abdominal wall):

• Pain in the groin and testicles or labia

• Other sections of the abdomen

Trigger points along the upper rim of the pubic bone and the lateral half of the inguinal ligament (inter-nus and rectus abdominis muscles):

• Pain in the area of the urinary bladder to the point of urinary bladder spasms

• Inguinal pain

• Retention of urine

Trigger points in the transversus abdominis, above the insertion of the ribs:

• Upper abdomen between the arches of the ribs

Trigger points in the rectus abdominis, above the navel:

• Painful band across the back at the height of the thoracolumbar junction (TLJ)

Trigger points in the rectus abdominis, at the height of the navel on the lateral edge of the muscle:

• Abdominal spasms and colic-like pain

• Pain in the ventral abdominal wall without strict pattern

Trigger points in the rectus abdominis, below the navel:

• Dysmenorrhea

• Painful band across the back at the height of the sacrum

Trigger point in the pyramidalis:

• Between the symphysis and the navel, near the center line

Associated Internal Organs

The acute abdomen impresses by firmly tensing the abdominal wall. We can explain this as a segmental viscerosomatic reflex: the abdominal muscles react with a calming hypertonus to the peritoneal irritation of the segmentally associated organ.

After organic disorders are cured, trigger points regularly persist in the abdominal muscles.

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Fire Up Your Core

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Responses

  • MELODY
    Who is the muscle chains?
    4 years ago
  • Selina
    WHAt muscles or organs are on left side of body upper torso?
    2 years ago

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