Muscle knots in the Scalenes are located on the sides of the neck, running from the cervical vertebrae down to the first and second ribs, often located below other neck muscles. These muscle knots can refer pain to a surprisingly wide area, including the chest, shoulder, upper back, arm, forearm, and even into the hand and fingers, often mimicking conditions like thoracic outlet syndrome or cervical radiculopathy. You may feel tingling, numbness, or aching in the arm and hand, especially the thumb and index finger, even though the actual source of the discomfort is in the neck.