Intercostal Muscles

Pointer Plus The Pointer Plus is an easy to use trigger point (TP) locator which incorporates a push button stimulation feature to immediately treat Trigger point pain.

The Intercostal muscles are muscles of the chest.

Anatomical Attachments: The internal and external intercostal muscles have a criss-crossing arrangement.

• Origin: Attach to the inferior border of the rib above.
• Insertion: Attach to the superior border of the rib below.

Action: Draw adjacent ribs together, elevate and depress the ribs in inspiration.

Nerve Supply: Corresponding Intercostal nerves.

Vascular supply: Posterior intercostals, costocervical trunk, anterior intercostal branches of internal Thoracic, musculophrenic, and costocervical trunk arteries.

• Primary: The primary referral pain pattern predominantly is localized to the site of the TrP; however it may traverse anteriorly rather than posteriorly toward the spine.
• Satellite or associated triggers: Serratus Anterior.

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Trigger Point Signs and Symptoms: There is difficulty in lying on the side where the TrP is evident, also attributed to an Intercostal TrP is the symptom of an irregular heart beat or arrhythmia. Exquisite pain may be experienced upon deep inhalation, sneezing, coughing, or laughing.

Trigger Point Activating and Perpetuating Factors: The most common activating factors would be poor ergonomics e.g. leaning to one side while sitting, direct trauma, excessive coughing, or a tight lateral band in a bra. TrPs not only can form in the post surgical adhesions following thoracic surgery, but also occur incidentally to that surgery in the intercostals even though there was no incision made at that sight. Shingles or herpes zoster activates TrPs, just as the ensuing episodic post herpetic neuralgia will. Episodes of post herpetic neuralgia may be experienced for months after the initial outbreak. Persons who have a compromised auto-immune system or who are elderly are at the greatest risk for contracting this painful condition. Persistent emotional stress exacerbates the symptoms during the initial outbreak and can serve as a triggering mechanism for post herpetic episodes of neuralgia. Currently, there have been medications developed to prevent and manage Herpes zoster.

Differential Diagnosis: (Segmental, Subluxation, Somatic dysfunction) T4 or T10 radiculopathy, Herpes zoster, Rib Subluxation/dislocation, Rib separation, Fibromyalgia, Cardiac disease/arrhythmia, Slipping Rib Syndrome (Tietze syndrome), Costochondritis, Bruised ribs, Rib fracture, Myocardial infarction, tumor, Pleurisy, Pleural effusion, Intrathoracic disease, Breast cancer/neoplasm, Polymyalgia rheumatica, Polymyositis, Fibromyalgia, Osteoarthritis, Osteoporosis, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

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