Acupuncture for Infraspinatus Trigger Points
The infraspinatus is one of the rotator cuff muscles that helps to provide mobility and stability to the glenohumeral (shoulder) joint. The other three rotator cuff muscles are the supraspinatus, subscapularis, and teres minor.
Infraspinatus pain is one of the most common causes of shoulder pain and is the most prevalent trigger point found in cases of chronic shoulder pain.
Read more to learn about the infraspinatus muscle, trigger points associated with it, and how acupuncture and dry needling can help relieve infraspinatus pain naturally.
Infraspinatus Pain Symptoms
Front of Arm Pain
Front of Shoulder Pain
Mid-Thoracic Back Pain
Back of Neck Pain
Painful Weak Grip
Problems Holding Arms Up (as when folding sheets)
Radial Forearm Pain
Thumb & Radial Hand Pain
If you are having trouble reaching into your back pocket, getting your arm into a coat, fastening a bra, or reaching to your night stand by your bed, it’s possible that infraspinatus trigger points are the culprit.
Origin and insertion of the Infraspinatus Muscle
Infraspinatus muscle
The infraspinatus originates along the medial two-thirds of the infraspinous fossa below the spine of the scapula. It inserts at the posterior aspect of the greater tubercle of the humerus. This means the infraspinatus connects from the shoulder blade to the back of the arm. It is one of the four rotator cuff muscles.
Trigger points and muscle tightness in the infraspinatus can cause the muscle to pull on the back of the arm and cause pain in the shoulder blade, outer shoulder, front of the shoulder, and down the arm.
Actions of the Infraspinatus Muscle
Laterally rotate the shoulder (glenohumeral joint)
Adduct the shoulder (glenohumeral joint)
Stabilize the head of the humerus in the glenoid cavity.
The infraspinatus muscle is positioned underneath the lower trapezius muscle, below the supraspinatus, above the teres minor and major muscles, and lateral to the rhomboid muscles. The primary action of the infraspinatus is to laterally rotate the shoulder and secondarily to adduct, and stabilize the shoulder.
A review of the infraspinatus muscle shows that it is an important shoulder stabilizing muscle and has the 2nd largest anatomic footprint on the humerus bone out of the rotator cuff muscles, after the subscapularis muscle. Since it is a muscle that acts on the shoulder joint, it is susceptible to rotator cuff tears, most commonly due to anterior shoulder dislocations.
A rotator cuff repair can be managed surgically or conservatively. Surgery is commonly recommended when symptoms have lasted 6 to 12 months, the tear is more than 3 cm, significant weakness or loss of function, or recent acute injury. Conservative treatment for a rotator cuff tear can include acupuncture, physical therapy, massage, and exercise.
Rotator cuff pathology is a common cause of shoulder pain and leads to 4.5 million office visits and 40,000 surgical procedures in year in the United States.
Synergists and antagonists of the infraspinatus muscle
The main synergists of the infraspinatus are the teres minor and posterior deltoid for lateral rotation of the shoulder. The infraspinatus also works synergistically with the other rotator cuff muscles to stabilize the head of the humerus in the shoulder joint (glenoid cavity) during flexion and abduction of the shoulder.
During rotation of the arm, the subscapularis, pectoralis major, and anterior deltoid muscles are antagonists to the infraspinatus and posterior deltoid.
A research article about infraspinatus fascia found that there may be a link between anterior/posterior deltoid and trapezius trigger points due to the infraspinatus fascia acting as a bridge between these muscles. This helps to explain why infraspinatus pain and trigger points are most commonly found in patients with shoulder pain.
Infraspinatus Trigger Points
Infraspinatus Trigger Point Locations
According to Travell & Simons, infraspinatus trigger points are usually the major source of intense, deep pain in the front of the shoulder.
Additionally, the infraspinatus pain referral pattern can move down the radial aspect of the arm to the hand and fingers. These trigger points can also cause upper posterior cervical pain and pain at the medial border of the scapula over the rhomboid muscles.
Trigger points in the infraspinatus can be associated with trigger points in other muscles like the teres minor, anterior deltoid, posterior deltoid, supraspinatus, trapezius, and biceps brachii.
A 2011 study showed that in 72 cases of chronic, unilateral, non-traumtic shoulder pain, infraspinatus trigger points were the most common.
The study found that active myofascial trigger points were present in all 72 cases. They were most prevalent in the infraspinatus (77 percent) and upper trapezius (58 percent) muscles. In 67 of the 72 cases there were also latent trigger points found, most commonly in the teres major (49 percent) and anterior deltoid (38 percent) muscles. The median number of active trigger points associated with the shoulder pain was 6 and ranged from 2 to 16 muscles.
In other cases of referred pain to the shoulder, the infraspinatus is a likely source of pain along with the supraspinatus and levator scapulae muscles.
Signs and Symptoms of Infraspinatus Pain and Trigger Points
Difficulty reach behind - like when in a car or fastening a bra strap
Impaired sleep that involves difficulty sleeping on the same side
Pain when brushing teeth or combing hair
Unable to medially rotate and adduct shoulder at the same time
infraspinatus tightness can lead to shortening of the muscle which then pulls on the back of the arm and shoulder. This can lead to issues like rotator cuff tendonitis and other shoulder issues. Infraspinatus trigger points can mimic the pain of sub-deltoid bursitis, suprascapular nerve entrapment (with supraspinatus muscle), bicipital tendinitis (with biceps brachii muscle), scapulohumeral dysfunction (with pectoralis major and minor, and long head of the biceps), and glenohumeral joint arthritis. If those conditions are ruled out then it is likely an infraspinatus trigger point that is causing the pain.
Besides the infraspinatus, trigger points in the teres minor and deltoid are common causes of front of shoulder pain. Teres minor trigger points often accompany infraspinatus trigger points since both muscles laterally rotate the shoulder. Together, they can extend the referral areas to include the back of the shoulder as well.
How Do Infraspinatus Trigger Points Form?
Trigger points in the infraspinatus form from activities that keep the muscle in a static position for long periods of time or acute overload the muscle. Activities that place excess strain on the infraspinatus include twisting the arm during a fall, raising the arm behind and away for long periods of time, and poor shoulder posture. The infraspinatus muscle is likely to be activated during movements that are unusual so people can often pinpoint how their infraspinatus trigger points formed.
Infraspinatus Pain Referral Patterns
Primary symptoms of infraspinatus trigger points include front of shoulder pain, mid-thoracic back pain, painful weak grip, and problem holding arms up. Secondary symptoms of infraspinatus trigger points include front of arm pain, back of neck pain, radial forearm pain, and thumb and radial hand pain. The most common pain pattern from infraspinatus trigger points is an intense, deep pain in the front of the shoulder. The can radiate over the anterior deltoid muscle down over the biceps brachii, and even down to the radial forearm and hand.
Infraspinatus Trigger Point Locations
Trigger points #1, #2, and #3 (blue): The common locations of infraspinatus trigger points occur in the midportion of the muscle and refer pain deep in the front of the shoulder, over the biceps brachii, and down the arm to the hands and fingers.
Trigger point #4 (green): A less common infraspinatus trigger point can form close to medial border of the scapula near the adjacent rhomboid muscles. It refers pain to the other side of the shoulder blade over the rhomboid muscles and is difficult to distinguish from lower trapezius trigger points.
Infraspinatus Pain Referral Patterns
Infraspinatus Associated Trigger Points
Teres minor: chief synergist in lateral rotation of shoulder
Anterior deltoid: lies in primary referred pain zone of infraspinatus
Supraspinatus: works with infraspinatus to raise arm and back
Biceps brachii: may work along with supraspinatus and infraspinatus when lifting arm up
Teres major: counters lateral rotation of infraspinatus
Latissimus dorsi: counters lateral rotation of infraspinatus
Subscapularis: antagonist muscle of infraspinatus
Pectoralis major: antagonist muscle of infraspinatus
How Can Acupuncture Release Infraspinatus Trigger Points?
Trigger point acupuncture or dry needling can provide infraspinatus muscle release by identifying the taut bands of muscle that create the pain referral pattern and eliciting a twitch response to relax the muscle to restore function, improve range of motion, and reduce pain.
One study showed that myofascial release techniques in the infraspinatus muscle, which includes trigger point release, can help relieve shoulder pain.
Identifying trigger points and providing infraspinatus muscle release with acupuncture or dry needling and is one of the most effective ways to relieve pain in this muscle.
After releasing trigger points with acupuncture, there will generally be soreness for 24-72 hours after the treatment which will feel like intense workout soreness.
Book now with one of our expert acupuncturists to start relieving your infraspinatus pain.
READY TO SCHEDULE YOUR APPOINTMENT?
CALL OR TEXT US AT (917) 830-4440
OR CONTACT US BELOW
