Deep aching beneath the scapula that is difficult to localize or reach manually
Body region
Upper Back
Trigger points
1
documented in this muscle
Common symptoms
3
patterns cataloged
Common causes
4
contributory factors
Illustrated overview
Serratus Posterior Superior · Regional source example
Right serratus posterior superior: anterior and posterior regional pain patterns. In C, scapular abduction exposes the marked region; D shows the same region beneath the scapula in its usual position, marked with a dashed X. Travell and Simons, Fig. 47.1, p. 901. Regional illustration; not an individual map of a selected numbered point.
C: scapula abducted · D: marked region beneath the scapula
Regional muscle reference; this is not an individual map of the selected numbered trigger point.
Pain referral. Back of shoulder, upper arm
Pain Pattern
Back of shoulder
Posterior upper arm
Elbow
Fourth and fifth fingers
What This Pain Feels Like
You may feel a deep, nagging ache under your shoulder blade that is very difficult to reach or relieve on your own. This pain often radiates to the back of the shoulder and can travel down the arm to the little finger. It tends to worsen with deep breathing and is often described as a constant background pain that never fully goes away. This pattern is commonly confused with rhomboid pain, but the ache sits deeper and closer to the scapula border.
What Patients Report
Deep ache in upper back
Pain wrapping around to shoulder
Arm pain
What Makes It Worse
Deep breathing
Overhead reaching
Poor posture
Exercise is chosen for the affected back or rib movement rather than to isolate this muscle. See the care options below.
Symptoms patients report
Deep upper back pain Deep aching beneath the scapula that is difficult to localize or reach manually
Shoulder pain Posterior shoulder ache referred from deep upper thoracic trigger point activation
Arm pain Referred pain down posterior arm toward elbow and ulnar hand distribution
Common causes
Poor posture Sustained thoracic kyphosis stretches serratus posterior superior beyond its resting length
Shallow breathing Restricted rib elevation demand overworks serratus posterior superior as inspiratory muscle
Stress Emotional tension causes sustained upper thoracic guarding affecting deep back muscles
Overhead work Prolonged arm elevation requires continuous upper rib stabilization by this muscle
Treatment & self-care
Immediate Relief
Tennis Ball Against Wall Under Scapula Edge
Stand with your back to a wall and place a tennis ball between the wall and the inner border of your shoulder blade. Lean into the ball with moderate pressure and slowly roll up and down along the scapula edge. When you find a particularly tender spot, hold steady pressure for 20-30 seconds until you feel the tension release.
Duration
3-5 minutes per side
Frequency
2-3 times daily
Expect
May temporarily ease shoulder or upper-back tenderness and improve comfort during movement.
Exercises
Thoracic Rotation Stretch
Sit on a chair with your feet flat on the floor. Cross your arms over your chest and slowly rotate your upper body to one side as far as comfortable, keeping your hips facing forward. Hold the end position for 15-20 seconds, breathing deeply. Return to center and repeat to the opposite side. Perform 5 repetitions per side.
Duration
3-5 minutes per session
Frequency
2-3 times daily
Expect
Aims to improve comfortable trunk movement for bending, turning and reaching.
Exercises
Scapular Stability Exercises (Wall Slides)
Stand with your back flat against a wall, feet about 12 inches from the base. Press your arms against the wall with elbows bent at 90 degrees. Slowly slide your arms upward along the wall as high as you can while keeping your back, elbows, and wrists in contact with the wall. Hold at the top for 3 seconds, then slowly lower. Perform 3 sets of 10 repetitions.
Duration
5-7 minutes per session
Frequency
Once daily, 5 days per week
Expect
Practises controlled shoulder-blade movement during reaching and other arm tasks.
Exercises
Deep Breathing with Rib Expansion
Sit or stand with good posture. Place your hands on the sides of your lower rib cage. Inhale slowly and deeply through your nose for 4 counts, focusing on expanding your ribs laterally into your hands. Hold for 2 counts, then exhale slowly through your mouth for 6 counts. Perform 10 breath cycles per session.
Duration
3-5 minutes per session
Frequency
3-4 times daily
Expect
Practises relaxed breathing with comfortable rib movement.
Lifestyle Changes
Posture Correction for Forward Head
Set hourly reminders to check your posture during desk work. Perform chin tucks by gently drawing your chin straight back as if making a double chin, hold for 5 seconds, and release. Adjust your monitor to eye level and position your keyboard so your shoulders are relaxed. Avoid sustained forward head posture during reading or phone use.
Duration
Ongoing throughout the day
Frequency
Hourly posture checks with chin tucks
Expect
Aims to make sustained tasks more comfortable through support and regular position changes.
Professional Treatment
Professional Trigger Point Dry Needling
Consult a physical therapist or practitioner trained in dry needling for treatment of deep serratus posterior superior trigger points. Because this muscle lies beneath the rhomboids and trapezius, it can be very difficult to treat with manual pressure alone. Dry needling can access these deeper layers directly for more effective release.
Duration
20-30 minute treatment session
Frequency
Weekly for 3-6 sessions as recommended by the practitioner
Expect
May temporarily ease shoulder or upper-back tenderness and improve comfort during movement.
Caution Ensure the practitioner is experienced with thoracic dry needling due to proximity to the lung. Mild soreness for 24-48 hours after treatment is normal.
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