■ Infraspinatus Muscle (Figs. 19.32,19.33) Origin
Infraspinous fossa of the scapula insertion
• Greater tubercle of the humerus (middle facet)
• Shoulder joint capsule
Action
• Outward rotation of the arm
• Shoulder joint stabilizer
Innervation
Suprascapular nerve (C5-C6)
Fig. 19.31
TP1 is found in the infraspinous fossa immediately below the spine of the scapula near the medial border of the scapula; TP2 somewhat further laterally (see also Fig. 19.25).
Referred Pain
• Ventral shoulder area
• Ventrolateral upper arm and forearm
• Radial palm and back of the hand
Associated Internal Organs
See Teres Major Muscle (p. 146).
Lateral border of the scapula (middle third), above the teres major
Insertion
• Greater tubercle of the humerus (lower facet)
• Shoulder joint capsule xi
Action
• Outward rotation of the arm
• Shoulder joint stabilizer
Innervation
Axillary nerve (C5-C6)
Trigger Point Location
In the lateral of the lateral border of the scapula between the infraspinatus and teres major muscles
Fig. 19.35
Referred Pain
• Posterior deltoid area, a little above the deltoid insertion
• Posterior upper arm
• Distal third of the lateral border of the scapula (below the teres minor)
• Inferior angle of the scapula
Insertion
Crest of the lesser tubercle of the humerus Action
• Inward rotation
• Shoulder joint stabilizer Innervation
Subscapular nerve (C5-C6) Trigger Point Location
TP1 In the area of the lower angle of the scapula TP2 Lateral in the muscle belly in the posterior axillary fold (see also Fig. 19.25)
Referred Pain
• Dorsal deltoid area
• Along the long head of the triceps
• Dorsal forearm
Associated Internal Organs
See teres major muscle below.
Fig. 19.35
• The scalene, supraspinatus, infraspinatus, teres major and minor, and deltoid muscles often develop trigger points as a result of slipped cervical disks (C4/C5, C5/C6, C6/C7)
■ Latissimus Dorsi Muscle (Fig. 19.36) Origin
• Spinous processes and supraspinous ligaments of all cervical, lumbar, and sacral vertebrae from T7 downward
« Thoracolumbar fascia
• Inferior angle of the scapula
Insertion
Crest of the lesser tubercle of the humerus Action
• Extension, internal rotation, and adduction of the arm
• Deep inhalation and forced expiration
Innervation
Thoracodorsal nerve (C6-C8) Trigger Point Location
In the free border of the posterior axillary fold around the height of the middle of the lateral border of the scapula (also see Fig. 19.1)
Referred Pain
• Lower angle of the scapula and circular in its vicinity
• Dorsal shoulder area
• Dorsomedial upper arm and forearm inclusive of fingers 4 and 5
Associated Internal Organs
None
■ Subscapularis Muscle (Figs. 19.37,19.38) Origin
Subscapular fossa
Insertion
• Lesser tubercle of the humerus
• Crest of the lesser tubercle of the humerus (proximal)
• Shoulder joint capsule Action
• Inward rotation
• Shoulder joint stabilizer
Innervation
Subscapular nerve (C6-C7)
Fig. 19.37
Near the lateral border of the scapula in the subscapular fossa. In addition, you find trigger points in the subscapular fossa further medially in the direction of the upper angle of the scapula.
Subscapularis
Subscapularis
Referred Pain
• Posterior shoulder area
• Entire surface of the scapula
• Dorsal upper arm up to the elbow
• Hand joint (dorsal and palmar)
Associated Internal Organs
None
• Nuchal ligament
• Spinous processes and supraspinous ligaments C7-T5
Insertion
Medial border of the scapula Action
Retraction of the scapula Innervation
Dorsal scapular nerve (C5) Trigger Point Location
Along and near the medial border of the scapula (see also Fig. 19.25)
Referred Pain Associated Internal Organs
• Along the medial border of the scapula between the Heart scapula and the paravertebral musculature
• Supraspinous fossa of the scapula
■ Deltoid Muscle (Figs. 19.40, 19.41, 19.42) Origin
• Clavicle (lateral third)
• Spine of the scapula
Insertion
Deltoid tuberosity
Action
• Abduction of the arm
• Ventral section: flexion, internal rotation
• Dorsal section: extension, external rotation
Innervation
Axillary nerve (C5-C6)
Trigger Point Location
• Ventral trigger points: in the upper third of the muscle belly in front of the glenohumeral joint and in the vicinity of its anterior border
• Dorsal trigger points: along the posterior edge of the muscle belly in its lower half
Referred Pain
■ Ventral trigger points: anterior and lateral deltoid area and upper arm
• Dorsal trigger points: posterior and lateral deltoid area and upper arm
Associated Internal Organs
See Teres Major Muscle (p. 146).
Deltoid
Triceps brachii, long head
TP of the anconeus
Triceps brachii, lateral head
Triceps brachii, medial head
Anconeus
Brachialis
Pronator teres
Biceps brachii, long head
TPs of the biceps brachii
Biceps brachii, short head
TP of the pronator teres
Coracobrachial^ Ridge of the shoulder blade
Biceps brachii, short head
Biceps brachii, long head
TPs of the biceps brachii
TP of the pronator teres
Deltoid
Triceps brachii, medial head
Anconeus
TP of the anconeus
Deltoid
TP of the coracobrachialis
Brachialis
Pronator teres
Triceps brachii, long head
Triceps brachii, lateral head
■ Coracobrachialis Muscle (Fig. 19.43) Origin
Coracoid process of the scapula Insertion
Medial side of the humerus (proximal half) Action
Flexion, adduction of the arm innervation
Musculocutaneous nerve (C5-C7)
Trigger Point Location
Palpate in the armpit between the deltoid and pector-alis major and press the muscle in its cranial section against the humerus.
Referred Pain
• Anterior aspect of the deltoid
• In a continuous line on parts of the upper arm, forearm, and back of the hand
Associated Internal Organs
None
■ Biceps Brachii Muscle (Fig. 19.44) Origin
• Long head: supraglenoid tubercle of the scapula
• Short head: coracoid process of the scapula
Insertion
• Radial tuberosity
• Bicipital aponeurosis
Action
• Flexion of the elbow
• Supination of the forearm
Innervation
Musculocutaneous nerve (C5-C6) Trigger Point Location
In the distal third of the muscle (see Fig. 19.40)
Referred Pain
• Ventral deltoid area
• Ventral upper arm in the course of the muscle
• Inner side of the elbow joint
• Suprascapular region
Associated Internal Organs
None
Fig. 19.47
■ Brachialis Muscle (Figs. 19.45,19.46,19.47) Origin
Surface of the humerus (distal half)
Insertion
• Ulnar tuberosity
• Coronoid process
Action
Flexion in the elbow joint Innervation
• Musculocutaneous nerve (C5-C6)
Trigger Point Location
TP1 Several centimeters above the inside of the elbow joint
TP2 In the upper half of the muscle belly
Fig. 19.46
Fig. 19.45
Fig. 19.47
Trapezius
Deltoid
Supraspinal
Short head of the biceps brachii
Latissimus dorsi
Pectoralis
Serratus anterior
Teres major
Coraco-brachialis
-Flexor digitorum superficialis (ulnar head)
Fig. 19.45
Biceps brachii
Supinator
Deltoid
Brachialis
Pronator teres (ulnar head)
Biceps brachii
Pectoralis minor
Subscapulars
Serratus anterior
Trapezius
Deltoid
Supinator
Long head of the biceps brachii
Teres major
Coraco-brachialis
Pronator teres Common head ol the flexors
Short head of the biceps brachii
Supraspinal
Tendon of the long head of the biceps brachii
Latissimus dorsi
Pectoralis
Deltoid
Brachialis
Extensor carpi radialis brevis Common head of the extensors
-Flexor digitorum superficialis (ulnar head)
Pronator teres (ulnar head)
Referred Pain
• Back of the hand in the area of the carpometacarpal joint 1 and base of the thumb
■ Triceps Brachii Muscle (Figs. 19.48,19.49) Origin
• Long head: infraglenoid tubercle of the scapula
• Lateral head: backside of the humerus (proximal half)
• Medial head: backside of the humerus (distal half), inferomedial to the groove for the radial nerve
Insertion
Elbow joint capsule
Action
• Extension in the elbow
• Shoulder joint stabilizer
Innervation
Radial nerve (C7-C8)
• Inside of the elbow joint
• Ventral upper arm and deltoid area
Associated Internal Organs
None
Trigger Point Location
TP1 In the long head, a few centimeters distal of the place where the teres major crosses over the long triceps head
TP2 In the medial head ca. 4-6 cm above the lateral epicondyle on the lateral edge of the muscle
TP3 In the lateral head on the lateral edge of the muscle around the middle of the upper arm, that is, at the level of the palpation point for the radial nerve on the dorsal upper arm
TP4 In the medial head approximately above the olecranon
TP5 On the medial border of the medial head, a little above the medial epicondyle
Referred Pain
TP1 Dorsal upper arm
Dorsal shoulder region up to the neck Dorsal forearm up to the back of the hand (with the exception of the elbow)
TP2 Lateral epicondyle
Radial forearm TP3 Dorsal upper arm
Dorsal forearm TP4 Olecranon TP5 Medial epicondyle
Ventromedial forearm Fingers 4 and 5 palmar
Associated Internal Organs
None
Lateral epicondyle of the humerus (dorsal side)
Insertion
Elbow joint capsule
Action
Tensor of the joint capsule (prevents the joint capsule from getting caught during extension of the elbow)
Innervation
Radial nerve (C6-C8)
Trigger Point Location
Approximately distal of the annular ligament of the radius (see also Fig. 19.40)
Referred Pain
Lateral epicondyle
Associated Internal Organs
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