Posterior Scalene, Gross Anatomy

Description

Arising from the posterior tubercles of the mid cervical transverse processes, the posterior scalene descends inferolaterally to its attachment on the external surface of the second rib, positioned posterior to the middle scalene and deep to the prevertebral layer of deep cervical fascia. From a posterior neck and shoulder perspective, the muscle sits lateral to the cervical vertebrae and medial to the scapular girdle, with the occipital bone and upper cervical spine forming the superior midline framework. Adjacent bony landmarks include the clavicle and scapula, which bracket the lower neck and superior thorax, while the posterior scalene occupies the interval between the paraspinal musculature medially and the more lateral shoulder contour. Clear fascial planes matter here. They define the compartment. Posterior scalene anatomy is often overlooked in favor of the anterior scalene, yet it can be a symptomatic generator in cervicobrachial pain and thoracic outlet presentations, where hypertrophy or myofascial trigger points may contribute to lateral neck pain and referred symptoms toward the shoulder girdle. Its insertion on rib 2 also makes it a useful teaching structure for rib motion mechanics during forced inspiration and for differentiating the scalene group from levator scapulae and the upper trapezius in posterior neck dissection. Palpation and dry needling discussions hinge on knowing what lies deep and what lies posterior. Use this plate for gross anatomy courses covering the deep neck, fascia, and cervical spine, and for surgical anatomy references discussing posterior cervical approaches where layered dissection and compartment boundaries guide safe exposure. It also supports physical therapy and pain medicine content on scalene-related referral patterns and differential diagnosis of lateral neck pain versus cervical radiculopathy. Anatomical accuracy verified by SciePro's Medical Advisory Board.