How to Treat a Trigger Point - Subscapularis
Treating Subscapularis - Dr. Jonathan Kuttner
Subscapularis trigger points are a potent cause of shoulder pain
[Latin sub, under; scapularis, pertaining to the scapula]
Subscapularis
A member of the rotator cuff, which comprises the supraspinatus, infraspinatus, teres minor, and subscapularis.
The rotator cuff helps hold the head of the humerus in contact with the glenoid cavity (fossa, socket) of the scapula during movements of the shoulder, thus helping to prevent dislocation of the joint.
The subscapularis constitutes the greater part of the posterior wall of the axilla.
Subscapularis Trigger Points
Origin
Subscapular fossa and groove along lateral border of anterior surface of scapula.
Insertion
Lesser tubercle of humerus. Capsule of shoulder joint.
Action
As a rotator cuff muscle, stabilizes glenohumeral joint, mainly preventing head of humerus being pulled upward by deltoid, biceps, and long head of triceps. Medially rotates humerus.
Antagonists: infraspinatus, teres minor.
Nerve
Upper and lower subscapular nerves, C5, 6, 7, from posterior cord of brachial plexus.
Basic Functional Movement
Example: reaching into back pocket.
Referred Pain Patterns
Axillary trigger point: strong zone (5–8 cm) of pain in posterior glenohumeral joint, with a peripheral diffuse zone. Also radiating down posterior aspect of arm and anteroposterior carpals of wrist.
Indications
Rotator cuff tendinopathy, adhesive capsulitis (frozen shoulder), decreased external rotation with abduction, severe pain over back
of shoulder, restricted range of shoulder movement, inability to reach behind back, pain on throwing, clicking/popping shoulders, stroke (hemiplegia).
Causes
Sports related (especially swimming crawl, repeated forceful overhead lifting, baseball pitching/catching, cricket), post shoulder fracture/ dislocation, frozen shoulder syndrome, sudden unexpected loading of shoulder (e.g. fall), post- fracture, prolonged immobility (sling).
Differential Diagnosis
Impingement syndromes. Rotator cuff dysfunctions. Thoracic outlet syndromes. Cervical radiculopathy (C7). Cardiopulmonary pathology.
Connections
Infraspinatus, pectorals, teres minor, latissimus dorsi, triceps brachii, posterior deltoid, supraspinatus.
Self Help
Subscapularis is mostly hidden but self-massage techniques can be helpful for part of muscle that is exposed in and around armpit.
About Dr. Jonathan Kuttner
Dr Jonathan Kuttner (MBBCH, Dip Sports Med, Dip MSM, FRNZCGP, FAFMM) is a musculo-skeletal pain specialist who has spent the last 35 years in New Zealand working as a doctor, teacher and writer.
In 2014 Dr. Kuttner was the recipient of the NAMTPT Lifetime Award for Contribution to Myofascial Trigger Point Therapy.
Dr. Kuttner is regularly featured on national TV and radio.
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