Chronic Nonspecific Shoulder Pain -Look For Infraspinatus Trigger

At a recent conference, it was stated that the Infraspinatus muscle was key to all pain in the upper quadrant. He advised rolling a lacrosse ball back and forth it over it. You either sit or stand against a wall or lie down and roll it. Now a study on elderly with nonspecific shoulder pain shows it is involved.

J Geriatr Phys Ther. 2018 Jan/Mar;41(1):1-13.
doi: 10.1519/JPT.0000000000000079.
Dry Needling on the Infraspinatus Latent and Active Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized Clinical Trial.
Calvo-Lobo C. et al
https://www.ncbi.nlm.nih.gov/pubmed/26760574

• Sixty-six patients aged 65 years and older with trigger points in the ipsilateral infraspinatus of the painful shoulder
• Nonspecific shoulder pain was diagnosed if nothing else found on testing
• Technique: – “Hong’s fast-in and fast-out technique with multiple rapid
  needle insertion”:
  -lie down with bad side up
  –  “A headless 0.32 × 40-mm needle (Stainless steel, Agupunt A1041P, 158 Caspe, Barcelona, Spain 08013) was fi xed between the fi ngers of the nondominant hand and inserted perpendicular to the scapula toward theMTrP.”
  – “By means of metacarpophalangeal fl exion extension of the fi rst to second fingers of the dominant hand, the area was probed in different directions until presence of 1-LTR, a pain response and, usually, the referred pain pattern of the MTrP were obtained”
  – multiple insertions over 1-2 minutes were done “until reaching LTR exhaustion.”
  – press on spot 1 minute to stop bleeding

My technique is different –

• I find a good spot
• I needle area until I get a good trigger response, then electrically stimulate with pulses from a pointer plus for the count of 120 times.(80 times will sometimes do it but 120 times consistently gets relief) – stimulation should be enough to move the muscle but not painful
• Then move on to other satellites.
• Infraspinatus triggers tend to be closer to  scapular spine and closer to shoulder.
• Afterwards I work out all the remaining knots manually:
  – If you engageg infraspinatus transversely with your thumb either pushing cephalad (up towards head) or towards feet, you can quickly massage through it by thumping your thumb with a chripractic activator. Patient will complain it burns but it will be a good burn ( works well for upper trap and levator cscap too but that is another story)
  then rub the muscle 120 times and repeat sequence until muscle painfree.

Their results

Comment – I will have to add this to my one-shot-wonder catagory because who in their right mind would only hit triggers once?

I would have them hit those triggers by rolling a lacrosse ball (A Canadian sport if you must know…) – Tennis ball may be too soft.

It is suggested to apply as much pressure while still staying fully relaxed.

They talked about satellite triggers in Anterior Deltoid and Exensor carpi radialis brevis. I find triggers in the anterior deltoid are manually tough to get out but with the activator can gradually be relieved – needling would make it easy though.