Sternocleidomastoid (SCM)

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The Sternocleidomastoid is an anterior muscle of the neck.

Anatomical Attachments:

• Origin: The Sternal head attaches to the manubrium of the sternum; the Clavicular head attaches to the medial third of the clavicle.
• Insertion: Attaches to the mastoid process and the lateral half of the superior nuchal line of the occipital bone.

Action: Acting unilaterally – it draws the head toward the shoulder and rotates it pointing the chin superiorly and to the opposite side. Acting bilaterally – it flexes the head and raises the thorax when the head is fixed.

Synergist: Trapezius, Semispinalis capitis, Rectus capitis posterior major and minor, Oblique capitis superior, Splenius capitis, Longissimus capitis.

Antagonist: Longus capitis, Rectus capitis anticus.

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Nerve Supply: Accessory Nerve (Cranial nerve XI).

Nerve Entrapment: According to Travell and Simons, the Spinal accessory nerve (Cranial nerve XI) is occasionally entrapped in a hypertonic SCM, such as Wryneck or Spasmodic torticollis, with resulting paresis of the ipsilateral Trapezius.

Vascular supply: Sternocleidomastoid branch of the occipital and thyroid arteries, muscular of suprascapular artery, and the occipital of posterior auricular artery.

• Primary: The pain refers to the face and cranium. The Sternal Division: the Lower end – The pain refers downward over the upper portion of the sternum; the Mid-level – The pain refers homolaterally, it refers across the cheek, superiorly deep into the orbit and supraorbital ridge, inferiorly it refers pain to the maxilla, and the upper teeth. It is frequently confused with a Trigeminal neuralgia or Bells Palsy. However, unlike the Palsy, there is no ptosis, (Horner’s Syndrome) or facial drooping. The pain is also referred to the back of the tongue, deep into the throat and to the tip of the chin, which can cause problems with swallowing. The Upper end – The pain refers posteriorly to the ear and to the vertex of the scull. Travell and Simons make reference to its referral pattern as resembling a scull cap in distribution. Autonomic phenomena attributed to the sternal division include excessive tearing, blurred vision and additionally cause dizziness, vertigo and syncope. The Clavicular Division: the Mid level – The pain refers across the forehead, homolaterally; and when it is severe, refers pain bilaterally, across to the other side. The Upper end – The pain refers homolaterally deep in the ear, posterior auricular regions, cheek and molar teeth.
• Satellite or associated triggers: Pectoralis, Sternalis, Masseter, Temporalis, Orbicularis Oculi, Frontalis, and Digastric.

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Trigger Point Signs and Symptoms: Blurring of vision, unilateral deafness, soreness of neck, reddening of the conjunctiva, tearing of eyes, tension headaches, facial neuralgia, cervical cephalalgia, lymphadenopathy, stiff neck, dizziness, and vertigo.

Trigger Point Activating and Perpetuating Factors: Recurrent infections, paradoxical breathing, sleeping on 2 pillows, structural inadequacies of the body, bird watching with binoculars, persistent cradling of a telephone receiver on one’s shoulder, tilting of head to one side, overhead work, painting, sheet rocking ceilings, vigorous rotation of the neck and head e.g. whiplash or trauma that may be experienced subsequent to sporting endeavors.

Differential Diagnosis: Ménière’s disease, Cerebellopontine tumors, Intracranial vascular lesions, Multiple sclerosis, Inflammation of labyrinth, Hemorrhage into pons, Epilepsy (Seizure disorder), Neurological disease, (Segmental, Subluxation, Somatic dysfunction) C1 or C2 radiculopathy, Subacute meningitis or Peripheral neuropathy, Polyneuropathy, Polymyalgia rheumatica, Fibromyalgia, Carotid or vertebral artery obstruction, Cerebral aneurysm, Vestibular disease, Tetanus, Congenital and Spasmodic torticollis (Wryneck syndrome), Trigeminal neuralgia (Tic douloureux), Headaches, Tension myalgia, Somatization disorder, Ocular Disease, Stinger or burner, Acceleration/Deceleration injury (Whiplash), Hangover, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

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