Subscapularis Muscle: Trigger Point Pain
The subscapularis lines the front of the shoulder blade (scapula), laying between the shoulder blade and the ribs. It is one of four rotator cuff muscles and is always a prime suspect in frozen shoulder (adhesive capsulitis).
Trigger points (TrPs) in the muscle cause deep sharp pain in the back of the shoulder. The pain may continue down the inside of the upper arm. You may also have a sore or a tender spot on the front of the shoulder.
Another indication TrPs in the subscapularis is aching and tenderness in the back of the wrist.
Contents Of Article:
Subscapularis Referred Pain Pattern
Where is the subscapularis muscle?
The subscapularis lines the underside of the shoulder blade (scapula) and connects to the upper arm (humerus).
What movements does it control?
- Twists the arm in toward the body
- Assists in lifting the arm to the side away from the body
Looking for detailed muscle anatomy? The Subscapularis Muscle Anatomy Page has origin, insertion, innervation, and blood supply information. It also lists agonists and antagonists for each muscle action.The Subscapularis Muscle
Subscapularis Muscle Trigger Points Symptoms:
Trigger points in the subscapularis can make you not want to move your shoulder and arm. Twisting the arm can cause a sharp pain in the back of the shoulder. You may experience a constant ache in the shoulder that makes it difficult to sleep at night. Pain and tingling may be felt on the inside of the upper arm.
Another symptom that is often not connected to this muscle is an aching in the back of the wrist and an exceptionally tender spot on the back of the wrist. This along with the previous symptoms nearly always points to trigger points in the subscapularis.
- Severe pain deep in the back of the shoulder
- Pain in the inside of the upper arm
- Pain over the shoulder blade area
- Persistent aching in the wrist with extreme tenderness in the back of the wrist
- An extremely tender spot on the front of the shoulder
Trigger Points Information
Trigger points are small knots found in the muscle that when pressed increase pain in the area or send referred pain to another area of the body. To learn more about trigger points read Muscle Trigger Points and How They Contribute To Muscle and Joint Pain.TWD Recommends:
Sombra Warm Therapy Gel is recommended for relaxing muscles and relieving pain. It warms without the burning heat of other gels. An excellent choice for pain caused by trigger points, muscle/joint over-use and stiffness, and arthritis. (Not sold in stores)
Biofreeze Professional Gel is what I recommend for the pain and symptoms of muscle strains. It provides excellent pain relief and may help reduce inflammation caused by a strain. Recommended by medical professionals and trainers.
What Causes Trigger Points To Develop?
The supraspinatus is very susceptible to overexertion. Baseball pitchers, football quarterbacks, swimmers, and tennis players are susceptible to trigger points due to the repetitive rotation motions of the shoulder.
Musicians who play the violin, guitar, and banjo tend to develop TrPs due to the positioning of the arm and hand that holds the neck of the instrument.
- Falling and landing on your side and shoulder
- Sleeping on one side
- Immobilization of the arm for long periods (casted arm)
- Playing the violin, guitar, banjo
- Shot Put
Doctors and physical therapists often recommend TENS to relax the muscles and ease pain. The Belifu TENS Unit Muscle Stimulator is highly recommended and can be used on most areas of the body.
How To Avoid Development of Trigger Points
- Instead of carrying a heavy briefcase use a rolling briefcase. The same goes for suitcases while traveling.
- If you are doing overhead projects will a ladder put you closer to your work? Are there other tools you can use so you don’t need to keep your arms lifted as much?
- If you are working at a desk or table use a chair with arms that give support to your arms. This simple step will reduce and eliminate a lot of shoulder, arm, and upper back pain.
- Sports in which you swing a bat or racquet and hit a ball can overwork the supraspinatus. Play and practice within your fitness level and take time during play to stretch out the chest, upper back, and shoulders.
If you have or are buying a TENS unit, Doctor Jos’ book Maximum Pain Relief with Your TENS Unit will help you use your TENS unit to achieve maximum results. Highly recommended!
Supraspinatus Trigger Point Treatment
You might think you cannot treat the subscapularis because of its location between the shoulder blade and ribs, but that is not true. The technique is a little odd as you access the muscle through the armpit but once you learn how to reach the muscle it is easy.
I recommend anyone who has not practiced trigger point therapy to find a massage therapist, physical therapist or chiropractor with TrP therapy training. A person with training can confirm you have trigger points in the subscapularis and help you learn the treatment technique.
If you have experience doing TrP therapy and can follow directions as well as have the time and patience to practice you can use The Trigger Point Therapy Workbook as a learning resource. I recommend this book to anyone interested in learning about trigger points and how to do self-treatment to reduce and eliminate pain. The book has diagrams showing the location of the TrPs as well as how to do the treatment.
The best resource to learn how to treat small painful knots is The Trigger Point Therapy Workbook. The authors explain trigger points and their effects in everyday language, not medical speak. I recommend this book to anyone interested in learning to treat their own muscle pain.
How Long Before I Feel A Reduction In Pain?
Subscapularis trigger points can take time to fully deactivate. The good news is that most people feel a reduction in pain quickly, sometimes after the first treatment.
Many people do not keep up treatments until the TrPs are completely gone. It is important to be consistent and continue your treatments until the trigger points are deactivated and do not produce pain or other symptoms.
- The subscapularis is the prime muscle contributor to frozen shoulder
- Pain in the back of the arm and shoulder blade area along with a persistent ache in the back of the wrist is nearly always signs of subscapularis problems
- Another sign of subscapularis problems is difficulty putting on shirts and coats. To bring the arm back to put it in a sleeve is extremely painful and difficult.
- The subscapularis is likely the most problematic muscles of ball-playing athletes. Trigger points in the muscle can make it painful and sometimes impossible to throw or swing at a ball.
Subscapularis pain and symptoms can be similar to, contribute to, and be affected by these medical diagnoses:
- Adhesive capsulitis
- Frozen shoulder
- Rotator cuff tear
- Rotator cuff tendinitis
- Brachial plexus injuries
- Thoracic outlet syndrome
- Subdeltoid bursitis
- Bicipital tendinitis
- Dislocation of the glenohumeral joint
- Cervical arthritis or spurs
- Supraspinatus tendinitis
- Shoulder pointer
- Shoulder Sprain / Strain injury
Other muscles that should be considered and examined:
If you are an athlete who participates in sports or has a job that stresses the shoulder muscles you should consider having a cold therapy wrap on hand for treatments when you feel soreness or pain. This will help decrease inflammation in the muscles and around the shoulder joint and may prevent overuse injury or other damage to your shoulder.
Satellite trigger points associated with the subscapularis muscle:
If you have developed TrPs in the muscle there is a chance that you will find satellite trigger points in these muscles. To ensure complete treatment check and treat the following muscles:
- Pectoralis Major
- Teres Major
- Latissimus Dorsi
- Triceps Brachii
Other muscles that have similar pain patterns: