The scalene muscles (Latin: “ladder”) are three paired cervical muscles running from the cervical vertebrae to the upper two ribs. Hereby they form a roof over the pleura and the upper thorax. The innervation is carried by direct branches of the cervical and brachial plexuses (C3-6).
The scalene muscles are subdivided into:
- Anterior scalene muscle
- Middle scalene muscle
- Posterior scalene muscle
|Anterior scalene muscle||
Origin: anterior tubercle of transverse processes of vertebrae C3-C6
Insertion: anterior scalene tubercle of rib 1, superior border of rib 1 (anterior to subclavian groove)
Innervation: anterior rami of spinal nerves C4-C6
- bilateral contraction - neck flexion
- unilateral contraction - neck lateral flexion (ipsilateral), neck rotation (contralateral), elevates rib 1
|Middle scalene muscle||
Origin: posterior tubercles of transverse processes of vertebrae C3-C7
Insertion: superior border of rib 1 (posterior to subclavian groove)
Innervation: anterior rami of spinal nerves C3-C8
Function: neck lateral flexion, elevates rib 1
|Posterior scalene muscle||
Origin: posterior tubercles of transverse processes of vertebrae C5-C7
Insertion: external surface of rib 2
Innervation: anterior rami of spinal nerves C6-C8
Function: neck lateral flexion, Elevates rib 2
This article will discuss the anatomy and function of the scalene muscles.
Anatomy and supply
Scalenus anterior muscle
The anterior scalene muscle runs from the anterior tubercula of the transverse processes of the 3rd to 6th cervical vertebrae to the first rib.
Scalenus medius muscle
The middle scalene muscle originates at the posterior tubercula of the transverse processes of the 3rd to 7th cervical vertebrae and inserts at the first rib dorsally to the scalenus anterior muscle.
Scalenus posterior muscle
The posterior scalene muscle has its origin at the posterior tubercula of the transverse processes of the 5th to 7th cervical vertebrae and its insertion at the second rib.
The triangle between the scalenus anterior muscle, the scalenus medius muscle and the first rib form the interscalene triangle. The subclavian artery and the brachial plexus pass through this gap. In contrary, the subclavian vein runs ventrally from the scalenus anterior muscle.
Scalene muscles have three main functions:
- The scalene muscles elevate the ribs, and therefore the thorax. For that reason, they are also considered as accessory muscles of inspiration.
- Lateral flexion: a unilateral contraction bends the cervical spine to the side.
- Ventral flexion: a bilateral contraction of the scalenus anterior muscle causes a bending of the cervical spine to the front.
A too narrow interscalene triangle compresses the brachial plexus and subclavian artery (Scalene syndrome) causing paresthesia, more rarely circulatory disturbances (e.g. edema, ischemia) and pain. Typically the ulnar side and the little finger are affected.
Causes of the Scalene syndrome may be, amongst others, a hypertrophy of the scalene muscles due to chronic overload and variations or deformities of the first rib.