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 of TrPs in the subscapularis is aching and tenderness in the back of the wrist.

Contents of Article

    Where Is The Subscapularis Muscle?

    Subscapularis anatomy showing trigger points

    The subscapularis lines the inside of the shoulder blade (scapula) and connects to the upper arm (humerus).

    What Movements Does It Control?

    • Twists the arm in toward 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.

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    Subscapularis Muscles Trigger Points Symptoms:

    Subscapularis Referred Pain Pattern

    Trigger point pain in the subscapularis will 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 front of the shoulder. This, along with the previous symptoms, nearly always points to trigger points in the subscapularis.

    The symptoms:

    • Severe pain deep in the back of the shoulder
    • Pain going down 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 incredibly tender spot on the front of the shoulder

    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 recommended by medical professionals and trainers for the pain and symptoms of muscle strains. It provides excellent pain relief and may help reduce inflammation caused by a strain.

    What Causes Subscapularis Trigger Points To Develop?

    The subscapularis is susceptible to overexertion. Baseball pitchers, football quarterbacks, swimmers, and tennis players are prone 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 instrument's neck.

    Causes:

    • Falling and landing on your side and shoulder
    • Immobilization of the arm for extended periods (casted arm)
    • Playing the violin, guitar, banjo
    • Sports requiring repetitive shoulder/arm twisting and throwing motions
      • Baseball
      • Football
      • Tennis
      • Swimming
      • Bowling
      • Shot Put

    How To Avoid Development of Trigger Points In The Subscapularis

    •  If you play the guitar, banjo, or violin, take breaks and stretch out the shoulder, arm, wrist, and hand muscles.  If you are beginning or coming back to playing after a long break, gradually increase the time playing. Too much, too soon, will lead to pain.
    • Swimmers and athletes who throw or use swinging motions need to pay attention to conditioning levels. Do not push past your fitness level. If soreness and pain occur, take time to rest and give the muscle time to recover.

    TWD Recommends

    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 and pain. This will help decrease inflammation in the muscles and around the shoulder joint and may prevent overuse injury or other damaging injuries to your shoulder.

    Subscapularis 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 it is easy once you learn how to reach the muscle.

    I recommended that anyone who has not practiced trigger point therapy 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, The Trigger Point Therapy Workbook is an excellent resource. The book has diagrams showing the location of the TrPs as well as how to do the treatment.

    TWD Recommends

    Doctors and physical therapists often recommend TENS to relax muscles and ease the pain. The Belifu TENS Unit Muscle Stimulator is a great choice for treating shoulder, arm, and upper back pain.

    How Long Before I Feel A Reduction In Pain?

    Subscapularis trigger points can take time to 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 gone. It is important to be consistent and continue treatments until the trigger points are deactivated and do not produce pain or other symptoms.

    Interesting facts:

    • 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 difficult and painful.
    • 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 muscle 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
    • Carpal tunnel syndrome
    • Subdeltoid bursitis
    • Bicipital tendinitis
    • Dislocation of the glenohumeral joint
    • Cervical arthritis or spurs
    • Supraspinatus tendinitis
    • Shoulder pointer
    • Shoulder Sprain / Strain injury
    • C7 C8 radiculopathy

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    Other muscles that should be considered and examined:

    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
    • Deltoid

    Muscles with similar pain patterns

    Infraspinatus Muscle
    Teres Minor