Pain Pattern For Infraspinatus Muscle Trigger Points
Infraspinatus Trigger Point
The origin of the infraspinatus muscle is the infraspinous fossa of the scapula, and the insertion is located in the middle facet of greater tubercle of the humerus. The muscle is innervated by suprascapular nerve.
The three trigger points cause referred pain in the upper back, shoulder, and arm. The primary symptoms are front of shoulder pain, mid-thoracic back pain, painful weak grip, and problems holding arms up. The secondary symptoms cause back of neck pain, front of arm pain, radial forearm pain, and thumb and radial hand pain. The diagram below shows how the referred pain is generated from the trigger points from the shoulder to the hand.
Injuries to the teres minor are common in lifting when a person has an imbalance between the stronger chest, deltoid, and front shoulder muscles compared to the stabilizers on the back of the shoulder. The muscle imbalance places excessive strain on the teres major, teres minor, and infraspinatus muscles leading to strains and trigger points.
Trigger points in the shoulder muscles cause radiating pain from the back of the shoulder down the arm toward the hand. Many people feel the pain intense from the elbow to the back of the hand. Palpation of the trigger point increases the intensity of the pain. Decreasing pressure will minimize the intensity of pain.
Conservative Treatments
Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.
When these treatments are incorporated into a treatment plan patients heal faster and are less likely to have long-term pain or soft tissue fibrosis or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.
Treatment for shoulder injuries often requires a variety of exercises, stretches, conservative treatments, medical treatments, and home therapies. Shoulder injuries can become chronic if the appropriate steps are not taken.
Elbow injuries often occur in people with severe or chronic shoulder injuries. People begin trying to alter their shoulder motions to protect it. Unfortunately these altered body mechanics tend to overwhelm the muscles and tendons around the elbow. People often develop a secondary cubital tunnel syndrome, lateral epicondylitis, tricep tendonitis, medial epicondylitis, pronator teres syndrome, double crush, carpal sprains, wrist tendinitis, de quervain's tendonitis, finger extensor strains, or carpal tunnel syndrome.
Treatment for elbow injuries can be extensive if the tendinosis is severe. Mild strains can be treated at home with PRICE, home stretches, and exercises. Don’t wait for damage to both the shoulder and elbow to seek treatment and therapy.
Medical Treatments
NSAIDs are often prescribed for the initial acute injury stages. In severe cases that involve multiple joint regions, muscle relaxers or oral steroids can be given. Trigger point injections, botox, or steroid injections can be treatment options. Pain management is not usually required unless stronger medications or joint injections are required for treatment.
MRI and X-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. NCV testing may be utilized in cases that also involve muscle, sensory, or reflex loss.
Cervical spinal disc bulges and herniations onto the spinal cord or nerve root produce different symptoms and location of symptoms. Pain radiating in the hand is one symptom; along with numbness, weakness, fatigue, loss of sensation, or reduced reflexes. Your chiropractor, physical therapist, occupational therapist, or physician will evaluate your condition and make a proper diagnosis and treatment recommendations. Ask them any questions you might have about your injury.
Many people do have arthritis or degenerative changes in their shoulder, elbow, wrist, finger, or thumb joints. Arthritis does not mean you will always have pain in the joints. Degenerative arthritis means the structural Integrity of the bones have changed which alters its gliding, sliding, and hinging motions. The more severe the arthritic changes the easier it becomes to aggravate the joint and produce pain.
Osteoarthritis and rheumatoid arthritis will also slow healing and recovery time. Fortunately arthritic changes does not mean you will always have pain. Future pain will not necessarily be from the arthritis. People with severe shoulder arthritis can have no pain in their day to day activities. In fact many times people blame their arthritis pain on tendinosis or tendonitis of the shoulder stabilizing tendons that attach around the shoulder joint. Conservative treatment can improve shoulder pain; and people will have dramatically less pain with their work and home activities.
Conclusion
The upper extremity works as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.
Many therapeutic exercises can help restore proper strength and endurance to the elbow flexor muscles. Isometric exercises are often the initial treatment exercises. Followed by single plane rubber band exercises for elbow flexion, extension, pronation, and supination movements. Dynamic exercises involving stability ball push-ups can be performed on the wall or floor. The more unstable of the surface the more effort and stabilization is required of all the upper extremity muscles.
Push-ups on a stability ball enhances neuromuscular learning throughout the neck, scapula, shoulder, upper arm, and lower arm muscles. Additional strength exercises can be found on the arm and shoulder strengthening pages.
Our Chandler Chiropractic and Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents in Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ.