People complain of pain that disturbs their sleep when lying on the painful shoulder or on the opposite shoulder. It is a deeper pain than the illustration suggests. They have spent most of their time sleeping on that shoulder with that hand in front of them. It usually comes on gradually over months and eventually gets difficult to ignore. It may come on quickly when there is a trauma to the shoulder or an unusual sleeping situation. Often, the afflicted has tried many sleeping positions and would just like to get back to sleeping on their side, which is most restful.
They have trouble reaching back to tuck in a shirt or reaching to the floor of back seat of the car or extending their arm out to put something on the night stand. This can also create pain when stretching to reach overhead.
There are other symptoms that are common but not always present, The grip is weak on that hand and they have learned to be careful with things like a coffee cup. They may have pain in the back of the neck but usually don’t complain about that, at first. They may also have pain when reaching high overhead.
The trigger point is activated because sleeping on that shoulder has chronically displaced the humerus in the shoulder socket and the muscle has tightened to stabilize the shoulder. Just a trigger point doing its job.
The are test to see if the infraspinatus has active triger points. Either will produce pain in the shoulder.
The first one involves placing the forearm across the low back. It usually produces pain with the back of the forearm across the low back. Pain worsens as you reach up the middle of the back. It is notable that this may also indicate trigger points in the coracobrachialis with a different pain pattern.
In the second test, one’s reach is restricted when reaching around the back of the head. You cannot reach the edge of your mouth without pain in the shoulder when there are trigger points in the infraspinatus.
This post on self-care has a number of items that you can use to get relief on your own including stretching, trigger point release and sleeping positions that don’t aggravate the trigger point and wake you up in pain.
This post will sharpen your game as a therapist. It includes NMT routines for the rotator cuff tendons and the posterior scapula.
and some related posts…
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.
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