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Trigger Points Lateral Scapula

Fig. 19.30

■ 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

Trigger Point Location

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

Associated Internal Organs

• 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

Fig. 19.36

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

Trigger Point Location

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

Latissimus dorsi

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

Fig. 19.38

• 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

Fig. 19.49

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