Muscles
Subscapularis Trigger Points
Symptom Area: Upper Back, Shoulder and Arm
Subscapularis 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. Largest rotator cuff muscle; powerful internal rotator and anterior glenohumeral stabilizer.
Where you feel it
When the Subscapularis holds active trigger points, you usually notice it as carpal tunnel-like pain in wrist (watchband area) and problems holding arms up (as when folding sheets). Where the pain spreads: Posterior shoulder, deep axilla, and a 'wristband' band of pain around the wrist. What often sets it off: Frozen shoulder, throwing sports, post-surgical immobilization.
Overview
Largest rotator cuff muscle; powerful internal rotator and anterior glenohumeral stabilizer. Trigger points here are common in everyday and athletic populations and frequently contribute to the referred pain patterns described below.
Trigger point locations
Anterior surface of the scapula, palpable from the axilla.
Referred pain pattern
Posterior shoulder, deep axilla, and a 'wristband' band of pain around the wrist.
Palpation & testing
Palpate the muscle belly along its accessible course. Reproduction of the patient's familiar pain on palpation supports involvement.
Common causes
Frozen shoulder, throwing sports, post-surgical immobilization.
Self-care & clinical treatment
Side-lying internal rotation, doorway ER stretches. Clinically: needling and axillary release.
Treatment protocol
For Subscapularis, the general protocol applies: sustained pressure release on the taut band, then stretch and active movement in the newly gained range.
Position and palpation: Palpate the muscle belly along its accessible course.
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
References
- • Travell & Simons — Myofascial Pain and Dysfunction
- • 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:
