Electricians, painters, dancers, and competitive athletes such as swimmers and pitchers may develop anterior scalene syndrome due to excessive frictioning of cervical nerves as they traverse through fibrotic anterior and middle scalene tendons at the interscalene triangle. Symptoms may present in the anterior neck, chest wall or down into the arms and hands sometimes making it difficult to hold onto objects or to reach overhead. Prolonged anterior and middle scalene spasm due to injury, poor posture or overuse can also cause residual problems as they tug on the first rib pulling it up against a drooping clavicle. When the brachial plexus gets squashed between the clavicle and rib, a condition termed ‘costoclavicular syndrome’ arises. This disorder is one of the leading contributors to thoracic outlet syndrome (TOS).

Because the shoulder and neck area consist of very complex body parts with muscles and connective tissues going in all possible directions, therapists must focus intent on correctly assessing postural strain patterns prior to ‘chasing the pain’. A few commonly applied provocation tests for assessing TOS such as the Adson maneuver (scalenes), ‘Hands-up’ (pec minor), Allen (radial pulse) and the Elevation maneuver for costoclavicular canal impingement may be used. These tests may or may not momentarily reproduce symptoms, but are sometimes helpful in ruling out other causes which may produce similar symptoms.

Due to the overlapping of symptoms, it’s often difficult to make a definitive assessment using provocation tests. Fortunately, advancements in nerve imagery using Magnetic Resonance Neurography are providing more accurate monitoring of exact sites of peripheral nerve damage. These tests, accompanied by thorough history and posturofunctional evaluations, are extremely helpful for massage and functional movement therapists when it comes to treating entrapment sites that irritate the nerve bundle and bring sensation to the arm and hand.