Subclavius

The Subclavius is a muscle of the shoulder.

Anatomical Attachments:

• Origin: Attaches to the cartilage at the 1st rib junction.
• Insertion: Attaches to the inferior surface of the clavicle.

Action: Stabilizes and pulls the clavicle down and forward.

Nerve Supply: Nerve to Subclavius (C5, C6).

Vascular supply: Clavicular branch of the thoracoacromial artery.

Vascular entrapment: Subclavian artery.

• Primary: The pain refers across the anterior shoulder, down the anterior surface of the arm, skipping the elbow, to refer down the radial aspect of the forearm, then skipping the wrist, to refer into the radial half of the hand involving the thumb, the pointer and the middle finger.
• Satellite or associated triggers: Deltoids, Teres Minor.

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Trigger Point Signs and Symptoms: Symptomatology is similar to that of a Thoracic outlet syndrome, with the arm and forearm pain excluding the elbow and wrist being a cardinal indicator. Due to possible entrapment of the subclavian artery it is possible to have a positive Adsons Test, especially when the shoulders are elevated (Modified Adsons Maneuver).

Trigger Point Activating and Perpetuating Factors: Persistent shoulder elevation e.g. sitting with arms too high in a chair, leaning on one elbow at a desk, or sleeping on ones side with their arm elevated above their head.

Differential Diagnosis: Brachial plexus entrapment, Thoracic Outlet Syndrome (Scalenus anticus, Costoclavicular, or Cervical rib syndromes), (Segmental, Subluxation, Somatic dysfunction) C5 or C6 radiculopathy, Angina Pectoris, Myocardial Infarction, Frozen Shoulder (Adhesive Capsulitis), Subclavian artery entrapment, Rotator Cuff Injury, Dislocated Clavicle, Fractured clavicle, Separated Shoulder, Charcot’s Arthropathy, Fibromyalgia, Systemic lupus erythematosus, Osteoarthritis, Osteoporosis, Stinger or Burner, Eosinophilic fasciitis, Tetanus, Systemic infections or inflammation, Nutritional inadequacy, Metabolic imbalance, Toxicity, Side effects of medication.

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