I’ve become much more familiar with trigger point referral patterns and treating these out the past couple years since I started using Functional Dry Needling techniques. A couple of the more common trigger points I end up dry needling and/or using Graston Technique to treat in the shoulder are the infraspinatous and teres minor. Active trigger points in these muscles can refer pain to the anterior and middle shoulder, and on occasion will also refer pain down the arm.
Check out the typical trigger points and referral patterns below:
A current patient of mine presented with R shoulder and scapular pain of 2 year duration. Trunk rotation was limited to 50% bilaterally (dysfunctional and painful – DP) and R shoulder medial rotation extension (MRE) reach only to L4 (DP). Palpation of the infraspinatous trigger point (most superior and lateral) referred significant pain to the anterior shoulder and slightly down the lateral arm reproducing her typical pain. The teres minor trigger point referred pain to the middle deltoid area.
Post trigger point dry needling of these trigger points the patient’s trunk rotation improved to 90% (dysfunctional still but non-painful now) and R shoulder MRE to T9 (still DP but much less pain).
Following up with corrective exercises, in this case thoracic rotation mobility and scapular stabilization, full trunk rotation was achieved without pain and R shoulder MRE improved even more to T7.
Joe Heiler PT, CSCS
Joe Heiler MSPT is the owner and content manager of SportsRehabExpert.com, a website dedicated to advancing the education of rehab and performance professionals. The site focuses on orthopedic and sports physical therapy topics through webinars, audio interviews, articles, manual therapy and exercise videos, and more.
Joe is also the owner of Elite Physical Therapy and Sports Performance in Traverse City, MI specializing in orthopedics and sports medicine, as well as athletic performance training. He is Graston Technique (GT) Certified as well as a GT Instructor, SFMA and FMS trained, and is passionate about a number of soft tissue and manual techniques including Trigger Point Dry Needling and manipulation.