top of page
The scalenus syndrome
What is the scalenus syndrome?

The scalenes are a group of muscles attached on the first neck vertebras and down on the first ribs. With the ribs, the clavicle and the small pectoral muscle, they form what we call the upper thoracic outlet.

It is a passage where nerves and blood vessels are travelling down to the arms.

The function of the scalenes are both rotating the neck but also elevating the first rib while breathing in.

Their anatomy makes them vulnerable to both bad breathing patterns and mechanical neck dysfunctions.

When scalene muscles tense up, it sometimes happens that they compress nerves and arteries which then give the typical symptomatology such as:

- numbness in the arm/hand

- cold hands or fingers

- tingling in the hand or fingers

- pain or weakness in the arm

- heaviness in the arm/hand

Most of the time, these signs are caused by certain arm positions, efforts or breathing patterns.

Treating a scalene syndrome in osteopathy

The scalene syndrome is a pure mechanical issue.

As the scalene muscles tense up, the first rib gets elevated against the clavicle reducing the thoracic outlet space.

This reduction causes a compression syndrome which affects nerves, veins and arteries travelling in the thoracic outlet.

Patients then start feeling the typical symptomatology described above.

The osteopath will first release the scalene muscles with some specific muscle energy techniques. He will then mobilize the clavicle, the shoulder and the upper cervical region to restore the mobility. At last, when everything is released, he will gently push down the first ribs to reopen the thoracic outlet to its original state.

Osteopathy often gets good results regarding the scalene syndrome. Usually 2 to 3 treatment sessions remove 90% of the symptoms.


The anatomy of the scalenes muscles and the thoracic outlet.

Stress and scalene syndrome

It is very current that a scalene syndrome is related to stress.

When people are getting stressed, they start breathing with the thorax instead of breathing down into the stomach.

The scalene muscles are "secondary breathing muscles", meaning that they are here to support the action of the diaphragm when doing an effort. The problem is that, when people are stressed, they stop using their diaphragm and start using only the secondary breathing muscles for the breathing function.

The scalene muscles then start tensing up and bring the symptomatology described above.

A good osteopathic treatment will work on the thoracic outlet region but will also work on mobilizing/releasing the diaphragm with specific exercises and mobilizations. Teaching patients to breath correctly and constructively will also be a part of the osteopathic treatment.

bottom of page