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Muscle deep-dives

Triceps Brachii trigger points: referred pain, palpation and release

A clinical deep-dive on Triceps Brachii: trigger point locations, the referred pain pattern they produce, palpation landmarks, activating factors and an evidence-based release protocol.

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Triceps Brachii trigger points: referred pain, palpation and release
Triceps brachii — four classic trigger points across the three heads: TrP1 (long head, upper posterior arm) refers up the back of the shoulder and down the back of the arm; TrP2 (medial head, distal posterior arm near the elbow) refers to the posterior elbow and dorsal forearm; TrP3 (lateral head) refers to the posterolateral upper arm; TrP4 (medial head near the medial epicondyle) refers focally to the medial elbow — a frequently overlooked cause of 'tennis elbow / golfer's elbow' pain and posterior shoulder pain that mimics rotator cuff pathology.

Why this muscle causes pain

Extends the elbow; long head extends the shoulder. Trigger points here are common in everyday and athletic populations and frequently contribute to the referred pain patterns described below.

Where the trigger points sit

Three heads across the posterior arm.

The referred pain pattern

Posterior shoulder, lateral epicondyle, and dorsal forearm — a hidden cause of 'tennis elbow' pain.

How to find it by palpation

Palpate the muscle belly along its accessible course. Reproduction of the patient's familiar pain on palpation supports involvement.

What sets it off

Push-ups, dips, sustained overhead writing, sleeping with arm overhead.

Self-care that actually helps

Cross-body stretch, scapular control. Clinically: needling each head.

Symptoms this muscle produces

Clinically, this muscle turns up in the workup of back of arm pain, back of shoulder pain, front of arm pain, upper thoracic back pain, dorsal forearm pain and lateral epicondylar pain. Those are the complaints its referral zone overlaps, which is why a patient may present with any of them and never mention the muscle itself.

Muscles covered

Studies cited

Every claim in this article traces back to one of the sources below.

  1. Kietrys 2013 — Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013;43(9):620-34 ↗
  2. Gattie 2017 — The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2017;47(3):133-49 ↗
  3. Boyles 2015 — Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther 2015;23(5):276-93 ↗
  4. Charles 2019 — A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points. J Bodyw Mov Ther 2019;23(3):539-46 ↗
  5. Cagnie 2013 — Physiologic effects of dry needling. Curr Pain Headache Rep 2013;17(8):348 ↗
  6. Fernández-de-las-Peñas 2019 — Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019;12:1899-911 ↗
  7. Shah 2015 — Myofascial trigger points then and now: a historical and scientific perspective. PM R 2015;7(7):746-61 ↗
  8. Halle 2016 — Pertinent dry needling considerations for minimizing adverse effects. Int J Sports Phys Ther 2016;11(5):651-62 ↗
  9. Boyce 2020 — Adverse events associated with therapeutic dry needling. Int J Sports Phys Ther 2020;15(1):103-13 ↗
  10. Hong 1994 — Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil 1994;73(4):256-63 ↗
  11. Simons & Travell — Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins, Baltimore ↗

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