Muscles
Infraspinatus Trigger Points
Symptom Area: Upper Back, Shoulder and Arm
Infraspinatus Trigger Points are explored here through their location and referred pain pattern. Muscle knots is an everyday term used for tender muscular spots; myofascial pain describes pain involving muscle and its surrounding connective tissue. The most common rotator cuff source of deep anterior shoulder pain — pain felt at the front but coming from the back of the scapula.
Where you feel it
When the Infraspinatus holds active trigger points, you usually notice it as front of shoulder pain, mid-thoracic back pain, painful weak grip and problems holding arms up (as when folding sheets). Where the pain spreads: Deep anterior shoulder pain (felt 'inside' the joint), spreading down the lateral arm and sometimes into the forearm and radial hand. What often sets it off: Overhead activity, throwing, sleeping on the shoulder, scapular dyskinesis, frozen shoulder.
Overview
Fills the infraspinous fossa of the scapula and inserts on the greater tubercle of the humerus. External rotator of the shoulder and dynamic stabilizer of the glenohumeral joint. Trigger points are extremely common in throwing athletes and desk workers.
Trigger point locations
Two primary points in the muscle belly, slightly inferior to the spine of the scapula. Often very tender even without complaints when palpated.
Referred pain pattern
Deep anterior shoulder pain (felt 'inside' the joint), spreading down the lateral arm and sometimes into the forearm and radial hand.
Palpation & testing
With the patient prone or side-lying, palpate just below the spine of the scapula. A taut band reproducing the patient's anterior shoulder pain is diagnostic.
Common causes
Overhead activity, throwing, sleeping on the shoulder, scapular dyskinesis, frozen shoulder.
Self-care & clinical treatment
Lacrosse ball against the wall on the infraspinous fossa, sleeper stretch with care, scapular control work. Clinically: dry needling is particularly effective here.
Treatment protocol
For Infraspinatus, the general protocol applies: sustained pressure release on the taut band, then stretch and active movement in the newly gained range.
Position and palpation: With the patient prone or side-lying, palpate just below the spine of the scapula.
Regional precaution for clinicians: Over the upper back and shoulder girdle the pleura lies immediately deep to thin muscle, so pneumothorax is the key risk; needling is performed tangentially or against a bony backstop (rib, scapula), never perpendicular to an intercostal space.
Primary Symptoms
Secondary Symptoms
Often confused with
These muscles cause the same primary symptoms, so they are checked together:
Related muscles in this region
Related articles
- Subscapularis: the hidden muscle behind frozen shoulder
- Referred pain: why the spot that hurts is rarely the spot that needs treatment
- The infraspinatus: why the back of your shoulder blade makes the front of your shoulder hurt
- Why pain spreads: satellite trigger points, and whether deactivating one quiets its neighbours
- Burning pain between the shoulder blades at the desk: the trigger points that cause it
- Do stretching and exercise actually change a trigger point? What the trials show
References
- • Travell & Simons, Vol. 1
- • 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
- • 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
- • Effectiveness of trigger point dry needling for multiple body regions: a systematic review — J Man Manip Ther 2015;23(5):276-93
- • 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
- • Physiologic effects of dry needling — Curr Pain Headache Rep 2013;17(8):348
- • 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
- • Myofascial trigger points then and now: a historical and scientific perspective — PM R 2015;7(7):746-61
- • Pertinent dry needling considerations for minimizing adverse effects — Int J Sports Phys Ther 2016;11(5):651-62
- • Adverse events associated with therapeutic dry needling — Int J Sports Phys Ther 2020;15(1):103-13
- • 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
- • Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.) — Williams & Wilkins, Baltimore
Medically reviewed by: Marco Aruffo — physiotherapist since 2006, specialised in myofascial pain · Last reviewed:
