Anterior Scalene Syndrome 

Anterior scalene syndrome is a grouping of disorders occurring when the nerves in the space between the first rib and the collarbone end up becoming compressed. This causes pain in the neck and shoulders, as well as numbness in the fingers. This area is known as the thoracic outlet and hence a common name for this condition is thoracic outlet syndrome (TOS). 

Common causes of the condition are physical trauma from being in a car accident, anatomical defects, pregnancy and repetitive injuries. There are instances where doctors aren’t able to determine what the cause of the syndrome is. Treatment often includes pain relief and physical therapy. Most of the time, these approaches work, but injections and surgery is also an option to treat the condition in severe cases. 

It is believed that the anterior scalene muscle can compress nerves and blood vessels around the front and side of the neck. So the symptoms in the arm vary between a dull ache, throbbing, sharp pain, and a dead arm pain. 

What Causes Anterior Scalene Syndrome? 

Different experts put the causes down to different underlying problems, but currently the general consensus is that the problem is caused by poor posture, whereby the shoulders are rounded forwards and the head is in a forward position. Addressing the posture is fundamental to correcting the pain. Poor breathing mechanics may also play a factor, which can shorten the anterior scalene muscle and could potentially cause some compression. 

How to Treat Anterior Scalene Syndrome: 

  1. Physical Therapy – If you are suffering with neurogenic anterior scalene syndrome, you will often go through physical therapy first. Soft tissue and mobilisation techniques will be used. You will learn the proper methods of doing exercises to help strengthen and stretch the muscles in the shoulder to open the thoracic outlet, improve posture and increase movement. Over the course of time, these exercises will help to alleviate pressure from the nerves and blood vessels.
  2. Osteopathy and Physiotherapy – Osteopaths and physiotherapists have a keen interest in anterior scalene syndrome, and will use techniques to the neck including soft tissue massage and manipulation to help improve posture and biomechanics of the head and neck.
  3. Sports Massage – Sports and deep tissue massage to the anterior scalene might help reduce tension and shortening of the muscle.
  4. Medication – You might be prescribed an anti-inflammatory medication to help decrease inflammation, encourage relaxation in the muscles and reduce pain.
  5. Clot-Dissolving Medication or Surgery – This is rare, but if you are suffering with arterial anterior scalene syndrome and have any blood clots, you might have to take this medication through your veins to help dissolve any clots. After you take the medication, you might be prescribed another medication to prevent the formation of new clots. If the other options haven’t been effective, you might have to undergo surgery to eliminate any progressive neurological issues. 


  • If you are prone to anterior scalene syndrome, you need to avoid any repetitive movements and refrain from lifting any heavy objects.
  • For those who are overweight, losing a few pounds can help to relieve and prevent some of the common symptoms associated with the condition.
  • Avoid carrying any heavy bags on your shoulder, as this can increase the amount of pressure in the thoracic outlet.
  • Perform exercises daily to help maintain strength in your shoulder.
  • Make sure to have your symptoms evaluated and treated from an early stage to prevent the condition from progressing.