FUNCTIONAL ANATOMY OF HUMAN SCALENE

MUSCULATURE: ROTATION OF THE CERVICAL SPINE

Anthony B. Olinger, PhD, a and Phillip Homier, BS b

ABSTRACT

Objectives: Actions of the scalene muscles include flexion and lateral flexion of the cervical spine and elevation
of the first and second ribs. The cervical rotational qualities of the scalene muscles remain unclear. Textbooks
and recent studies report contradictory findings with respect to the cervical rotational properties of the scalene
muscles. The present study was designed to take a mechanical approach to determining whether the scalene
muscles produce rotation of the cervical spine.
Methods: The scalene muscles were isolated, removed, and replaced by a durable suture material. The suture material
was attached at the origin and then passed through a hole on the corresponding rib near the central point of the
insertion. The suture material was pulled down through the corresponding costal insertion hole to simulate contraction
of each muscle.
Results: The simulated anterior, middle, and posterior scalene muscles, working independently and jointly, produced
ipsilateral rotation of the cervical spine. The upper cervical spine rotated in the ipsilateral direction in response to
the simulated muscle contraction. Findings were similar for the lower cervical spine with the exception of 2
specimens, which rotated contralaterally in response to the simulation.
Conclusion: Experimental models of the scalene muscles are capable of producing ipsilateral rotation of the cervical
spine. The findings of this study support the accepted main actions of the scalene muscles. The clinical applications for
understanding the cervical rotational properties of the scalene muscles include the diagnosis, management, and treatment
of cervical pain conditions as well as thoracic outlet syndrome. (J Manipulative Physiol Ther 2010;33:594-602)
Key Indexing Terms: Neck Muscles; Musculoskeletal Manipulations; Biomechanics; Cervical Vertebrae

he scalene musculature of the lateral aspect of the points for the AS include originating from the second

T neck classically exists as 3 muscles: the anterior,

middle, and posterior scalene (Fig 1). Scalene
muscles vary with respect to their origin and insertions on
the cervical vertebrae and upper ribs.1 The scalene muscles
are also often complicated by the presence of fused fascicles
between muscles and additional muscles, such as the
scalenus minimus muscle.1
The anterior scalene (AS) classically arises from the
anterior tubercles of transverse processes of the third
through sixth cervical vertebrae and inserts on the scalene
tubercle of the first rib (Fig 1). Variations of the attachment
a
Assistant Professor, Department of Anatomy, Kansas City
University of Medicine and Biosciences, Kansas City, Mo.
b
Anatomy Fellow, Department of Anatomy, Kansas City
University of Medicine and Biosciences, Kansas City, Mo.
Submit requests for reprints to: Anthony B. Olinger, PhD,
Assistant Professor, Department of Anatomy, Kansas City
University of Medicine and Biosciences, 1750 Independence
Ave, Kansas City, MO 64106 (e-mail: aolinger@kcumb.edu).
Paper submitted March 11, 2010; in revised form March 11,
2010; accepted June 8, 2010.
0161-4754/$36.00
Copyright © 2010 by National University of Health Sciences.
doi:10.1016/j.jmpt.2010.08.015
cervical vertebra, absence of attachment to the sixth cervical
vertebra, and insertion onto the second or even third rib.2
The middle scalene (MS) muscle classically arises from the
posterior tubercles of transverse processes of the second
through seventh cervical vertebrae and inserts onto the first
rib (Fig 1). Variations of the attachment points for the MS
include originating from the transverse processes of the
atlas and inserting onto the second rib.2 The posterior
scalene (PS) classically arises from the posterior tubercles
of transverse processes of the fourth, fifth, and sixth
cervical vertebrae and insert onto the second rib (Fig 1). The
PS may also arise from the third and seventh cervical
vertebra and often fuses with the MS and first external
intercostal muscle to insert on the second or third rib.2
The actions of the scalene muscles are generally
accepted to include flexion of the cervical spine when the
scalene muscles contract bilaterally and lateral flexion of
the cervical spine when the muscles act unilaterally.3-6
When the cervical spine is stabilized, the scalene muscles
also act to elevate the first and second ribs during forced
inspiration.3-6 Whether the scalene muscles are individually
or collectively capable of rotating the cervical spine in
either the contralateral or ipsilateral direction remains
unclear. Two commonly used clinical anatomy textbooks
do not mention rotation of the cervical spine for the action

594
Journal of Manipulative and Physiological Therapeutics Olinger and Homier 595
Volume 33, Number 8 Scalene Muscles and Cervical Rotation

of any of the 3 scalene muscles.4,5 An anatomical textbook

devoted to the muscular system mentions the controversial
nature of the scalene's role in cervical rotation and then
concludes, based on muscle fiber directionality, that all 3
scalenes produce contralateral rotation of the cervical
spine.5 An anatomical textbook devoted to the spine lists
contralateral rotation of the cervical spine under the main
actions of the AS and MS muscles but not the PS muscle.3
The classic 1918, 20th edition of Anatomy of the Human
Body by Gray7 assigns no cervical rotational functional at
all to the scalene muscles, whereas the 29th American
edition of Gray's Anatomy edited by Goss8 states no
cervical rotational function for the AS but states that the MS
and PS muscles both rotate the neck slightly, with no
mention of direction.
Recent studies have reported contradictory findings with
respect to the rotational qualities of the scalene muscles as
they act on the cervical spine.9,10 Buford et al9 produced
ipsilateral rotation of the cervical spine in the macaque
monkey through electrical stimulation of the scalene
musculature. Furthermore, Buford et al9 were able to
produce a muscular stretch in both the macaque and human
with rotation of the cervical spine in the ipsilateral
direction. Falla et al10 were unable to detect a significant
signal from surface electrodes placed over the AS muscle
when the cervical spine was rotated using isometric rotation
against a moderate resistance. When compared with the
significant signal produced by the sternocleidomastoid
muscle, the signal produced by the AS was negligible.
Furthermore, where the sternocleidomastoid muscles
showed a significant difference between right and left
sternocleidomastoid muscles and right and left rotation,
Falla et al10 were unable to identify a significant difference
between ipsilateral and contralateral rotation of the cervical
spine for the AS muscle.
The present study was designed to take a very
straightforward, mechanical approach to determining
whether the scalene muscles produce rotation of the
cervical spine from a neutral position.

METHODS
The lateral neck regions of 7 preserved human cadavers
(6 female, 1 male) and 2 fresh/frozen female cadavers were
dissected to reveal the AS, MS, and PS muscles. The
preserved cadavers were perfused through the common
carotid artery with a 5% phenol/2% formaldehyde embalm-
ing fluid. The fresh/frozen cadavers were several weeks
postmortem and allowed to thaw for 3 days before

Fig 1. Lateral aspect of the cervical region demonstrating the

origin and insertion of the AS, MS, and PS muscles. A,
Photograph. B, Illustration.
596 Olinger and Homier Journal of Manipulative and Physiological Therapeutics
Scalene Muscles and Cervical Rotation October 2010

dissection. The 3 scalene muscles were isolated, and the

surrounding tissue and musculature were removed to
eliminate the rigidity produced by cadaveric musculature.
The skull and atlas were disarticulated at the atlantoaxial
joint to allow precise observation of the cervical spine. The
origin and insertion of each muscle were carefully identified
and photographed on each cadaver. The muscles were then
removed and replaced by a durable suture material. Because
the scalene muscles possess origins at different vertebral
levels, a length of suture was used to represent each distinct
tendinous origin. Suture material was tied at the origins of
each muscle by passing it through the transverse foramen of
each cervical vertebra. Because the scalene muscles
originate from different locations on the cervical transverse
processes, the corresponding knot was positioned at the
central point of the origin for each muscular attachment on
each cervical transverse process. For the AS muscle, the
origin knot was positioned over the anterior tubercle of the
cervical transverse process. For the MS and PS muscles,
the origin knot was positioned on the posterior tubercle
of the cervical transverse process with the PS knot posterior
to the MS knot. Suture material was then passed through a
hole or a notch on the corresponding rib near the central
point of the insertion. For the AS, a small notch was made
on the medial edge of the first rib through which the suture
material was passed. For the MS, the suture material was
passed through a small hole that was drilled through the first
rib posterior to the groove for the subclavian artery. For the
PS, the suture material was passed through a small hole that
was drilled through the second rib at the insertion point of
the PS muscle. This procedure was performed bilaterally on
all 9 cadavers (Fig 2).
With the cadaver in the supine position, the suture
material was pulled inferiorly to confirm that further
stabilization of the cervical spine would be necessary to
observe the sort of rotation hidden by the far more dramatic
lateral flexion of the cervical spine. It was also noted that
without bracing the rib through which the suture material
was being pulled, the ribs simply moved superiorly, which
diminished any sort of cervical movement.
The odontoid process of the axis was anchored to the
dissection table with durable suture material to prevent
lateral flexion of the cervical spine. The ribs were held in
place by the investigator and used for leverage when pulling
on the suture material during the trials intended to
reproduce scalene muscular contraction. Any slight move-
ment of the insertion ribs during the trials was negligible
and did not affect the more dramatic movement produced
among the cervical vertebrae.
The suture material was pulled down through the
corresponding costal insertion hole and attached to a
small pull spring scale. Two probes were inserted into the
Fig 2. Cervical region demonstrating the replacement of the
anterior tubercles on the transverse processes of the second scalene muscles with a durable suture material, producing an
(C2) and the seventh (C7) cervical vertebrae on the experimental model designed to simulate the actions of the scalene
contralateral cervical spine, away from the side being musculature. A, Photograph. B, Illustration.
Journal of Manipulative and Physiological Therapeutics Olinger and Homier 597
Volume 33, Number 8 Scalene Muscles and Cervical Rotation

tested. Preceding each trial, the probes were leveled to a

neutral position using a spirit or bubble level (Fig 3).
During each trial, the appropriate rib was braced; and the
scale was pulled inferiorly by an investigator who was
blinded as to the effect it was having on the cervical spine.
This was done to prevent the investigator from trying to pull
the muscle in a manner to produce a specific outcome and to
more accurately mimic flexion of each muscle. All of the
reference point measurements were taken from the
contralateral side, away from the side where the mock
flexion was occurring. As the degree of rotation would
likely be insignificant given the rigidity of the cadaveric
tissue and circumstances of the project design, no rotational
measurements were recorded. Likewise, because the
amount of force used to produce cervical rotation would
be insignificant given the rigidity of cadaveric tissue, the
actual amount of force used was not recorded for each trial
but was instead kept constant with the use of the pull spring
scale. The pull spring scale was pulled to 20 lb in each trial.
Three trials were carried out for each simulated muscle
individually and collectively on each cadaver mimicking
single muscle contraction as well as the contraction of all 3
muscles. Combinational muscle contractions (ie, AS
contracting with PS etc) were not performed given the
physiologic unlikelihood of being able to perform such
contractions. After each mock contraction, the 2 probes
were evaluated again using the spirit level. If the superior
probe traveled anteriorly, the mock muscular contraction
was recorded as having produced ipsilateral rotation. If the
superior probe traveled posteriorly, the mock muscular
contraction was recorded as having produced contralateral
rotation. In addition to monitoring the change in slope from
the superior to inferior probe, the direction that the inferior
probe traveled was also recorded. This procedure was
performed on each side of each cadaver, and the data were
collected and photographs were taken with each trial.
In addition to the mock contraction trials from a neutral Fig 3. Demonstration of the leveling of the probes, with no
position, the simulated scalene muscles were also con- simulation of the action of the scalene muscles. A, Photograph. B,
tracted using the above protocol from a rotated state in Illustration.
both the contralateral and ipsilateral directions. During
these trials, the cervical spine was manually rotated in investigator, the maneuver was recorded as having
either the contralateral or ipsilateral direction followed produced a stretch.
immediately by a different investigator pulling inferiorly Positive and negative controls for the testing method
on the suture material that traveled inferiorly through the described in this article were produced by mimicking the
corresponding insertion hole on the first or second rib. action of the splenius cervicis (SC) and longissimus cervicis
After each trial, the probes were evaluated to see if they (LC). The SC was chosen as the positive control because
had returned to neutral position. cervical rotation is among the accepted actions of this
To evaluate which direction the neck should be rotated muscle.3,6 The LC was chosen as the negative control
to produce a stretch of the scalene muscles, the suture because cervical rotation is not among the accepted actions
material was held firmly at its insertion for each simulated of this muscle.3,6 The lateral and posterior neck and upper
muscle on the corresponding rib; and the cervical spine was thoracic regions of a fresh female cadaver were dissected to
manually rotated in the contralateral and ipsilateral reveal the SC and LC muscles. The fresh cadaver was 3
direction. If the suture material was pulled taut or the days postmortem. The muscles were isolated, and the
maneuver produced enough force to pull the suture material surrounding tissue and musculature were removed. The
through the insertion hole, against the bracing of the skull and atlas were disarticulated at the atlantoaxial joint.
598 Olinger and Homier
Scalene Muscles and Cervical Rotation
The origin and insertion of each muscle were carefully
identified and then removed and replaced by a durable
suture material. A length of suture was used to represent
each distinct tendinous insertion of SC (C2-C4) and LC
(C2-C6). The SC classically also inserts on the transverse
process of the atlas; however, because these trials were
intended as a positive control for the movement produced
by the scalene muscles, which do not attach to the atlas, the
attachment of the SC to the atlas was omitted. Suture
material was tied at the insertion of each muscle by passing
it through the transverse foramen of each cervical vertebra.
The corresponding knot was located at the central point of
the insertion on each cervical transverse process with
special attention paid to the principle line of action of each
muscle. Suture material was then passed through a hole or a
notch on the corresponding thoracic transverse process near
the central point of the origin. For the SC, the suture
material was passed under a notch on the T3-T6 spinous
processes; and for the LC, the suture material was passed
through a hole on the T1-T5 transverse processes.
With the cadaver in the prone position, the suture
material was pulled inferiorly to confirm that further
stabilization of the cervical spine would be necessary to
observe the sort of rotation hidden by the far more dramatic
lateral flexion of the cervical spine.
The odontoid process of the axis was anchored to
prevent lateral flexion and extension of the cervical spine.
The suture material was pulled down through notches on
the corresponding thoracic spinous process for SC and
thoracic transverse process for LC and attached to a pull
spring scale.
During each trial, the scale was pulled inferiorly by an
investigator who was blinded as to the effect it was having
on the cervical spine. This was done to prevent the
investigator from trying to pull the muscle in a manner to
produce a specific outcome and to more accurately mimic
flexion of each muscle. The pull spring scale was pulled to
20 lb for each trial. Three trials were performed for each
muscle. All of the reference point measurements were taken
from the contralateral side, away from the side where the
mock flexion was occurring. During each trial, suture was
pulled inferiorly by an investigator to mimic the line of
action for the specific muscle being tested. After each mock
contraction, the 2 probes were evaluated again using the
spirit level. If the superior (C2) cervical transverse
processes traveled posteriorly, the mock muscular contrac-
tion was recorded as having produced ipsilateral rotation. If
the superior (C2) cervical transverse processes traveled
anteriorly, the mock muscular contraction was recorded as
having produced contralateral rotation. The change in slope
from the superior to inferior cervical transverse processes
was also monitored. As the degree of rotation would likely
be insignificant given the rigidity of the cadaveric tissue and
circumstances of the project design, no rotational measure-
ments were recorded. The study was approved by the
Journal of Manipulative and Physiological Therapeutics
October 2010
Kansas City University of Medicine and Biosciences
institutional review board.
RESULTS
Contraction of the AS, MS, and PS muscles was
simulated by pulling inferiorly on the suture material
through the corresponding hole on the appropriate insertion
rib. Without stabilization of the cervical spine or the
corresponding insertion ribs, simulation of the muscles
contraction, individually and collectively, produced lateral
flexion of the neck and elevation of the ribs.
With the cervical spine stabilized to prevent lateral
flexion and stabilization of the ribs, simulating the action of
the AS muscle caused the superior (C2) probe to travel
anteriorly in all 9 cadaveric specimens. Simulating the
action of the AS muscle produced a displacement of the
inferior (C7) probe in the anterior direction in 7 of 9
specimens; however, in 2 simulations, the inferior (C7)
probe traveled posteriorly. In 7 of the 9 cadavers, including
both fresh specimens, the inferior (C7) probe traveled
anteriorly upon simulating the action of the AS muscle,
though not as far as the displacement observed by the
superior (C2) probe, such that the 2 probes were no longer
level. The remaining 2 specimens were both preserved
cadavers, and the inferior (C7) probe traveled slightly
posteriorly in response to simulation of the action of the AS
muscle (Fig 4). Whether the inferior (C7) probe traveled
slightly anteriorly or slightly posteriorly, the slope between
the 2 probes changed such that the 2 probes were no longer
level. This action was extrapolated as an ipsilateral rotation
of the cervical spine. The fact that the inferior (C7) probe
traveled posteriorly in 2 of the test specimens suggests that,
in those 2 specimens, the lower cervical spine rotated in the
contralateral direction from the neutral position.
Simulation of the action of the MS muscle produced
similar results (Fig 5). Those results included anterior
displacement of the superior (C2) probe in all 9 specimens
and anterior displacement of the inferior (C7) probe in the
same 7 specimens that displaced anteriorly with activation
of the AS. Findings also included posterior displacement of
the inferior (C7) probe in the same 2 specimens that
displayed a posterior displacement of the inferior (C7)
probe with activation of the AS. The displacement of the
probes and the resultant change on the slope of the line
between the 2 probes were extrapolated as an ipsilateral
rotation of the cervical spine. The posterior displacement of
the inferior (C7) probe in 2 of the test specimens suggests
that, in those 2 specimens, the lower cervical spine rotated
in the contralateral direction from the neutral position.
Simulation of the action of the PS muscle produced
similar results (Fig 6). Those results included anterior
displacement of the superior (C2) probe in all 9 specimens
and anterior displacement of the inferior (C7) probe in the
Journal of Manipulative and Physiological Therapeutics
Volume 33, Number 8
Fig 4. Simulation of the action of the AS muscle and the resultant
anterior displacement of the superior probe by all 9 specimens,
with an anterior displacement of the inferior probe in 7 of 9
specimens and posterior displacement of the inferior probe in 2 of
9 specimens. A, Photograph. B, Illustration.
same 7 specimens that displaced anteriorly with activation
of the AS and MS muscles. Findings also included posterior
displacement of the inferior (C7) probe in the same 2
specimens that displayed a posterior displacement of the
inferior (C7) probe with activation of the AS and MS
muscles. The displacement of the probes and the resultant
change on the slope of the line between the 2 probes were
extrapolated as an ipsilateral rotation of the cervical spine.
The posterior displacement of the inferior (C7) probe in 2 of
the test specimens suggests that, in those 2 specimens, the
lower cervical spine rotated in the contralateral direction
from the neutral position.
The same findings were observed with simulation of
contraction of all 3 scalene muscles working together
Olinger and Homier 599
Scalene Muscles and Cervical Rotation
Fig 5. Simulation of the action of the MS muscle and the resultant
anterior displacement of the superior probe by all 9 specimens,
with an anterior displacement of the inferior probe in 7 of 9
specimens and posterior displacement of the inferior probe in 2 of
9 specimens. A, Photograph. B, Illustration.
(Fig 7). Those findings included anterior displacement of
the superior (C2) probe in all 9 specimens and anterior
displacement of the inferior (C7) probe in the same 7
specimens that displaced anteriorly with activation of the
AS, MS, and PS muscles when acting individually.
Findings also included posterior displacement of the
inferior (C7) probe in the same 2 specimens that displayed
a posterior displacement of the inferior (C7) probe with
activation of the AS, MS, and PS muscles when acting
individually. The displacement of the probes and the
resultant change on the slope of the line between the 2
probes were extrapolated as an ipsilateral rotation of the
cervical spine. The posterior displacement of the inferior
(C7) probe in 2 of the test specimens suggests that, in those
600 Olinger and Homier
Scalene Muscles and Cervical Rotation
Fig 6. Simulation of the action of the PS muscle and the resultant
anterior displacement of the superior probe by all 9 specimens,
with an anterior displacement of the inferior probe in 7 of 9
specimens and posterior displacement of the inferior probe in 2 of
9 specimens. A, Photograph. B, Illustration.
2 specimens, the lower cervical spine rotated in the
contralateral direction from the neutral position.
When the cervical spine was manually rotated in the
contralateral direction, all 3 simulated scalene muscles,
working individually and collectively, were capable of
returning the cervical spine to a neutral position. Further-
more, if the cervical spine was manually rotated in the
ipsilateral direction, all 3 simulated scalene muscles,
working individually and collectively, were capable of
returning the cervical spine to a neutral position.
The investigators also observed that, when they
anchored the suture material to the corresponding insertion
rib, they could easily produce a stretch of the suture material
by manually rotating the cervical spine in the contralateral
Journal of Manipulative and Physiological Therapeutics
October 2010
Fig 7. Simulation of the action of all 3 scalene muscles and the
resultant anterior displacement of the superior probe by all 9
specimens, with an anterior displacement of the inferior probe in 7
of 9 specimens and posterior displacement of the inferior probe in
2 of 9 specimens. A, Photograph. B, Illustration.
direction. It was possible to produce a stretch of the suture
material by rotating the cervical spine in the ipsilateral
direction; however, the force required to produce this
stretch was far greater than the force required to produce a
stretch toward the contralateral side.
To evaluate the reliability of the experimental simula-
tion, a positive control muscle (SC), the simulation of
which should produce cervical rotation, and a negative
control muscle (LC), the simulation of which should not
produce cervical rotation, were also tested. In the absence of
stabilization and anchoring of the odontoid process,
simulation of the SC and LC muscles produced extension
and lateral flexion of the cervical spine. With the odontoid
process anchored to prevent cervical extension and lateral
Journal of Manipulative and Physiological Therapeutics
Volume 33, Number 8
rotation, simulation of the SC caused the superior (C2)
probe to travel anteriorly and produced no movement of the
inferior (C7) probe. The displacement of the probes and the
resultant change on the slope of the line between the 2
probes were extrapolated as an ipsilateral rotation of the
cervical spine. With the odontoid process anchored to
prevent cervical extension and lateral rotation, simulation of
the LC muscle was unable to produce movement of either
probe. The absence of movement upon simulation of the LC
suggests that the LC muscle was incapable of producing
cervical rotation.
DISCUSSION
Simulation of the SC and LC as positive and negative
controls helped to validate the experimental design. The
SC is classically described as an ipsilateral cervical
rotator, and the simulation was able to produce ipsilateral
cervical rotation. Likewise, the LC is not classically
described as being capable of producing cervical rotation;
and the simulation of the LC was unable to produce
cervical rotation of any kind. The findings of the control
study support the observations of the simulated scalene
muscles, in that the controls lend some validity to the
experimental design.
The experimental simulations performed in this study
support the accepted main actions of the scalene muscles
in the current literature, that is, lateral flexion of the
cervical spine and elevation of the first and second ribs.
Given the exceedingly vertical nature to the line of action
of the scalene muscles, a characteristic that is exemplified
by the replacement of the musculature with suture
material, it is intuitive that lateral flexion of the cervical
spine and elevation of the first and second ribs are the
primary actions of the scalene muscles.
Numerous animal models have been developed to
evaluate the functions of scalene muscles.9,11-13 However,
application of animal models to the complex geometry of
the human cervical spine in an attempt to make claims about
the action and function of human musculature is question-
able. The findings of this study agree with the findings of
Buford et al9 where they concluded that the scalene muscles
produced ipsilateral rotation in both humans and macaques.
The clinical applications for an understanding of the
cervical rotational properties of the scalene muscles include
the diagnosis, management, and treatment of cervical pain
conditions as well as thoracic outlet syndrome. The
involvement of the AS muscle in certain varieties of neck
pain is well documented.14,15 Use of manual therapies to
treat neck pain often involves stretching and exercising the
associated musculature. Having a precise understanding of
the morphometry and function of that musculature is
integral to effectively and appropriately stretch and exercise
the associated muscles.
Olinger and Homier 601
Scalene Muscles and Cervical Rotation
Manual provocative diagnostic tests for thoracic outlet
syndrome often involve cervical rotation as part of the
positioning of the patient to reproduce the symptoms.
Despite the evidence that some of these tests have been
shown to be unreliable,16 citing a high number of false-
positive responses in healthy subjects,17 they are still used
by clinicians. Given the anatomical variability of the
interscalene triangle,18 the space between the AS and MS
and the first rib, which is one of the potential entrapment
sites for thoracic outlet syndrome, knowing which direction
to rotate the head to produce a maximum stretch of the
scalene muscles will more effectively reproduce the
symptoms of the patient.
Limitations
There is a potential limitation to the application of the
results extrapolated from the preserved cadavers given the
tendency for preserved tissue to be more rigid than fresh or
living tissue. However, the compliance between the
findings from the fresh cadavers and preserved cadavers
supports the results derived from the preserved specimens.
Furthermore, the fact that preserved tissue is more rigid and
the fact that we were able to produce rotation on the
preserved specimens suggest that, in a living subject, these
actions would simply be more exaggerated.
The 2 preserved specimens that displayed a contralateral
rotation of the lower cervical spine in response to simulated
scalene contraction may have been an artifact of postural
malformation and experimental design. Both specimens
possessed such a dramatic kyphotic curvature of the
thoracic spine that the lower half of the cadaver needed to
be elevated to obtain the requisite positioning to level the 2
probes. Elevating the lower half of the cadaver may have
corrupted the experimental design and led to the contra-
dictory findings observed with these 2 cadavers. It would be
interesting to perform these same simulations on an entire
population of cadavers possessing this same postural
malformation to see if the findings are consistent.
Another potential complicating factor for these results
stems from the fact that this was an experimental model
intended to mimic muscular contraction rather than the
actual muscle producing the action. Although every effort
was made to reproduce the morphometry of the 3 scalene
muscles with the space-occupying devices, musculature
does not always act in a linear fashion, given the
surrounding tissues, investing fascia, and differing penna-
tion angles. However, use of individual pieces of suture
material to represent each tendinous origin should have
addressed the range of pennation angles observed in
morphometry studies of the cervical musculature.19 Bio-
mechanical computer modeling of cervical musculature
based on morphometric observations supports the use of
multiple space-occupying devices to evaluate the force-
generating properties of cervical musculature.20
602 Olinger and Homier
Scalene Muscles and Cervical Rotation
CONCLUSION
Experimental models of the scalene muscles are capable
of producing ipsilateral rotation of the cervical spine. The
findings of this study support the accepted main actions of the
scalene muscles. The clinical applications for understanding
the cervical rotational properties of the scalene muscles
include the diagnosis, management, and treatment of cervical
pain conditions as well as thoracic outlet syndrome.
Practical Applications
• A mechanical experimental cadaveric model
designed to evaluate the rotational capabilities of
scalene musculature produced a slight ipsilateral
rotation of the upper cervical spine and a slight
contralateral rotation of the lower cervical spine.
• A simulation of scalene musculature on a cadaver
can be stretched by rotating the cervical spine in
both the ipsilateral and contralateral directions.
• An understanding of the rotational properties of
the scalene muscles has clinical applications to
cervical pain and the diagnosis and treatment of
thoracic outlet syndrome.
FUNDING SOURCES AND POTENTIAL CONFLICTS OF INTEREST
No funding sources or conflicts of interest were reported
for this study.
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