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The infraspinatus muscle is one of four muscles that make up the rotator cuff of the shoulder. It is a common source of pain for athletes, musicians, and desk workers. The infraspinatus muscle is easily accessible and responds well to palpation and trigger point injections. This article will discuss how to palpate the infraspinatus muscle and the treatments available for pain relief.
| Characteristics | Values |
|---|---|
| Muscle Type | Thick and Triangular |
| Muscle Location | Below the spine of the scapula and at the tuberculum majus |
| Muscle Function | Externally rotates the arm at the shoulder |
| Muscle Innervation | Suprascapular Nerve |
| Muscle Blood Supply | Suprascapular Artery |
| Common Issues | Trigger points, pain, impingement, and rotator cuff tears |
| Treatment | Self-massage, needling, and injections |
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What You'll Learn
The infraspinatus muscle's role in the rotator cuff
The infraspinatus muscle is a thick, triangular muscle that occupies most of the dorsal surface of the scapula. It is one of four muscles that make up the rotator cuff, along with the subscapularis, teres minor, and supraspinatus muscles. The rotator cuff is essential for the stability and mobility of the shoulder joint, which is the most flexible joint in the human body.
The infraspinatus muscle's primary function is to externally rotate the humerus and protect and stabilise the shoulder joint. It originates in the infraspinatous fossa of the scapula and inserts into the greater tubercle, or the middle facet of the greater tuberosity of the humerus. This muscle also assists in abduction and adduction movements of the arm.
The infraspinatus muscle is a common source of pain and injuries, especially in athletes, musicians, and desk workers. It is prone to developing trigger points, which can cause pain in the upper neck and shoulder. Impingement or tears in the rotator cuff can also occur, leading to pain and weakness during external rotation movements.
To evaluate the infraspinatus muscle, a lateral rotation test against resistance is performed with the elbow flexed and the arm in a neutral abduction/adduction position. This test is considered positive if weakness or pain is experienced during the movement. Additionally, palpation of the infraspinatus muscle is often done to identify trigger points or for injections, with the patient lying prone or on their side.
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Trigger points and pain relief
The infraspinatus muscle is a common source of pain for athletes, musicians, and desk workers. It is one of the four rotator cuff muscles, and it is easily accessible and responds well to trigger point IMT. Trigger points in the infraspinatus muscle can cause pain at the location of the trigger point and also send pain to other, seemingly unrelated areas of the body.
Trigger points are usually activated by stress on the muscle. Trigger points can be latent or active. Latent trigger points only hurt when pushed on, while active trigger points cause pain even without touch or motion. They can also restrict motion and cause muscle weakness.
To treat infraspinatus pain, a doctor may recommend rest, exercises, and stretching. NSAIDs like ibuprofen can also relieve pain and reduce swelling. Steroid injections can be used to provide temporary relief, but they can damage the muscle if done too often. Surgery is usually only recommended for severe injuries or if other treatments have failed.
There are also some self-massage techniques that can be used to relieve infraspinatus pain by treating its trigger points. One technique is to use a massage ball. Place the ball on the muscle and search for tender spots. Then, move your arm (rotate it, lift it, etc.) and see which range of motion is the most painful. Another technique is to use a tool like the Trigger Fairy. Place the Trigger Fairy's "head" on the muscle and search for tender areas.
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The infraspinatus test
The infraspinatus muscle is one of the four muscles of the rotator cuff. It is a common source of pain for athletes, musicians, and desk workers, especially those who work in a bent-over position, do a lot of desk work, or work with their arms over their heads.
This test may be combined with the Hawkins-Kennedy Impingement Sign and the Painful Arc sign to test for subacromial impingement. If all three tests report a positive result, the positive likelihood ratio is 10.56, and if all three tests are negative, the negative likelihood ratio is 0.17. If two of the three tests are positive, the positive likelihood ratio is 5.03.
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Injection procedures
Before administering an injection, it is important to wash your hands thoroughly with soap and warm water, paying attention to the area between the fingers and under the fingernails. Prepare the injection site by gently spreading the skin between two fingers and keeping the muscles relaxed. Clean the skin with an alcohol swab and allow it to air dry.
For the infraspinatus muscle, the patient should lie prone on an examination bed with the affected arm extended, internally rotated, and adducted, trying to reach the thoracic spine. This position is similar to the surgical "chicken wing" position. The infraspinatus muscle is then palpated from the infraspinous fossa of the scapula to the humerus, and trigger points are located below the spine of the scapulae. The injection sites are identified as points of maximal tenderness to deep palpation, reproducing the patient's pain complaint.
Once the injection site is identified, a 21- to 25-gauge, 1.5-inch needle is inserted at the point of maximal tenderness and advanced to the area of the trigger point. The needle is then carefully advanced through the skin and subcutaneous tissues, and the margin of the deltoid muscle and underlying infraspinatus muscle until it impinges on bone. The needle is withdrawn 1 to 2 mm out of the periosteum of the humerus, and the contents of the syringe are gently injected. There should be slight resistance to the injection.
After the injection, the needle is removed and appropriately disposed of, and hemostasis is applied for 30 seconds or as needed. The muscle is then put through gentle stretching or a range of motion as appropriate. It is important to protect the lung and prevent pneumothorax during this procedure.
It is crucial to note that the injection procedure may vary depending on the specific clinical situation and the patient's needs.
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Differentiating the infraspinatus from other muscles
The infraspinatus is one of the four muscles of the rotator cuff, along with the subscapularis, teres minor, and supraspinatus muscles. It is a thick triangular muscle that occupies the majority of the dorsal surface of the scapula.
The infraspinatus can be differentiated from the other muscles of the rotator cuff by its specific attachments, innervation, blood supply, and function. Firstly, the infraspinatus muscle attaches medially to the infraspinous fossa of the scapula and laterally to the greater tubercle of the humerus. This differentiates it from the subscapularis, which attaches to the anterior side of the scapula, and the teres minor, which attaches to the lateral side of the scapula.
Secondly, the infraspinatus is innervated by the suprascapular nerve, which arises from the upper trunk of the brachial plexus. This is a distinguishing factor from the subscapularis, which is innervated by the subscapular nerve. Additionally, the infraspinatus receives its blood supply primarily from the suprascapular and circumflex scapular arteries, with some anatomical variations influenced by individual anatomy.
Thirdly, the infraspinatus muscle has a specific function in externally rotating the humerus and stabilising the shoulder joint. This external rotation of the arm is a key differentiating factor from the other rotator cuff muscles. The infraspinatus works in conjunction with the teres minor to achieve this external rotation, and they are often considered a functional unit due to their close anatomical relationship.
Lastly, the infraspinatus is prone to trigger points, which can cause pain in the upper neck, shoulder, and seemingly unrelated areas of the body. This pain can be a differentiating factor from other muscles, as trigger points in the infraspinatus can create a unique pain referral pattern.
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Frequently asked questions
The infraspinatus muscle is a thick, triangular muscle that is part of the rotator cuff. It provides shoulder joint stability and externally rotates the arm at the shoulder.
The patient should lie prone or on their side, with the affected arm extended, internally rotated, and adducted. The therapist can stand or sit behind the patient. The medial and lateral borders of the scapula and the spine of the scapula are identified by palpation. The infraspinatus muscle is then palpated, and the palpating hand locates the taut band.
The infraspinatus muscle is a common source of pain for athletes, musicians, and desk workers. It is prone to developing trigger points, which can cause pain in the upper neck and shoulder. Infraspinatus tears are usually painless but can be identified by weakness in external rotation.
