The posterior scalene inserts via a flat tendinous slip onto the outer surface and upper border of the second rib, posterior to the serratus anterior. Its insertion is the most posterior and lateral of the scalene tendons, providing lateral neck flexion and accessory rib elevation.
The posterior scalene tendon insertion is at risk during cervical rib resection and posterior thoracic outlet decompression. Posterior scalene tightness contributes to the posterior component of thoracic outlet syndrome and to cervicogenic headache patterns. Trigger point injections in the posterior scalene target its tendinous portion near the rib insertion.
Traction injury at the second rib insertion producing posterior lateral neck pain, associated with whiplash injury and cervicogenic headache, managed with manual therapy and stretching.
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