When the trigger point is less advanced, people hold their arm out with the elbow away from their side, reach around to touch the back of the shoulder behind the arm pit and say that it hurts there. If I ask if they can reproduce the pain, they cautiously rotate their hand back to a throwing position to demonstrate and wince when it reaches a certain point. This trigger point will ruin a pitcher. I treat a 40ish man who lost his career in the minors and could not even throw a ball with special needs children because of this. He’s throwing again.
In more advanced stages, they cannot lift the arm to the side at shoulder level. They have often been diagnosed with “Frozen Shoulder.” These people have adapted their routines to accommodate their inability to raise their arm for activities like putting on a shirt and reaching up to get something out of a cabinet.
When the shoulder pain is the most bothersome pain, and I ask about the wrist, they usually have pain or sensitivity at their wrist. Some people will say that the wrist does not bother them but will scratch it or rub it occasionally as I work with them. (Trigger point referral is not always pain.)
When the wrist is the primary problem, it is bothersome to wear a watch. Some clients think that they have some form of carpal tunnel syndrome. It is interesting to see how often a server in a restaurant has a wrist brace, and when asked, complain that the shoulder was bothering them before the wrist did.
There are a few things you can do to minimize the discomfort before you get this addressed by a therapist. Sleep in a position the presses the head of the humerus back, instead of sleeping so that it is pushed forward. This can be done with putting the arm behind you, instead of in front of you while sleeping on your side. There are good stretching routines, especially Active Isolated Stretching but you will need a therapist who understands this problem and can guide you through the process.
Here’s a suggestion that you probably didn’t expect – rub a cube of Ice in your arm-pit for a few seconds and see if the range of motion increases or the pain decreases. This is a good indicator that subscapularis is your problem.
Get this addressed before it becomes advanced and debilitating. I have a number of clients that have let this go and end up with a serious problem that takes a lot of therapy to restore near-normal function. The seasoned trigger point specialist has a reliable solution to this problem.
This pain pattern comes from subscapularis, a rotator cuff muscle that lays flatly on the front of the scapula. It straps across the head of the humerus. Like other rotator cuff muscles, subscapularis secures the head of the humerus in the socket. It primarily internally rotates the upper arm. It is usually a thicker, more powerful muscle than the other rotator cuff muscles.
Teres Major is very similar in location, function and pain pattern. It should always be checked when working subscapularis.
Like scalenes and psoas, many therapists are over-focused on treating this muscle. When working on the tendon at the front of the shoulder, the humerus is mobilized and the trigger points in several other muscles are releases, including infraspinatus, teres major and supraspinatus. Mobilizing the shoulder reduces treatment time and intensity. I wrote about this in one of my original posts about The Godfather of Organized Pain.
Click on these categories to see if there is a referral pattern that better describes your concerns.
Tony Preston has a practice in Atlanta, Georgia where he sees clients.
He has written and taught about anatomy, trigger points and cranial therapies since the mid-90s.