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Integrated functional anatomy of the infraspinatus and teres minor (rotator cuff). Attachments, nerves, palpation, joint actions, arthrokinematics, fascia, triggerpoints, and behavior in postural dysfunction. Common activation exercises, subsystems, and strength exercises for the rotator cuff.

Infraspinatus and Teres Minor

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I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

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Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



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We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

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This course describes the anatomy and integrated function of the infraspinatus and teres minor muscle (a.k.a. the rotator cuff muscle, the shoulder external rotators, rotator cuff, glenohumeral joint rotators, or SITS muscles). The infraspinatus muscle originates on the infraspinous fossa of the scapula (posterior side of the shoulder blade), and the teres minor muscle originates on the upper 2/3rd of the lateral border of the scapula. Both the infraspinatus and teres minor insert into the greater tubercle of the humerus. The infraspinatus is composed of a higher proportion of type II muscle fibers, and the teres minor is composed of a relatively even distribution of type II and type I muscle fibers. The infraspinatus and teres minor muscles cross the shoulder joint (glenohumeral joint) and contribute to shoulder external (lateral) rotation, shoulder extension, and shoulder stabilization during all motions of the upper limb. This course also describes the role of the infraspinatus and teres minor in glenohumeral arthrokinematics, fascial integration, postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of the integrated function of the infraspinatus and teres minor for the detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation (e.g. rotator cuff injury, rotator cuff tear, infraspinatus pain, deltoid (shoulder) muscle pain, shoulder instability, shoulder impingement syndrome, rotator cuff repair and scar tissue development). As well as the synergistic function of the infraspinatus and teres minor (e.g. stabilization of the glenohumeral joint and upper arm, and contribution to external rotation with the posterior deltoid), and infraspinatus and teres minor exercises and techniques for enhancing sports performance, especially for the shoulder athlete (throwing athlete) (e.g. ensuring ideal infraspinatus and teres minor length for optimal shoulder stability, strength, power, and preventions of weakness and pain during throwing).

Brookbush Institute’s most recommended techniques for the Infraspinatus and Teres Minor Muscles (see videos below):

Infraspinatus and Teres Minor Static Manual Release

The posterior rotator cuff muscle infraspinatus

 Course Description: Infraspinatus and Teres Minor

Introduction

 1794, intransitive, back-formation from 

. Transitive sense from 1823. Related: Rotated; rotating. Rotator “muscle which allows a part to be moved circularly” is recorded from the 1670s. (

 “bottom of a sleeve,” mid-14c., cuffe “hand covering, mitten, glove,” perhaps somehow from Medieval Latin cuffia “head covering,” of uncertain origin. Sense of “band around the sleeve” is first attested in the 1520s; a sense of “hem of trousers” is 1911. (

By Anatomography - en:Anatomography (setting page of this image), CC BY-SA 2.1 jp, https://commons.wikimedia.org/w/index.php?curid=22787453

 "under, below, further on," from Latin infra (see 

 c. 1400, "backbone," later "thornlike part" (early 15c.), from Old French espine "thorn, prickle; backbone, spine" (12c., Modern French épine), from Latin spina "backbone," originally "thorn, prickle" (

 late 14c., "of or pertaining to birthdays," from Latin natalis "pertaining to birth or origin," (Old Latin gnasci; see 

"originating inferior to the spine of the scapula"

 – a Latin word meaning "rounded" or "cylindrical" - (

 (n.)), from Latin minor "less, lesser, smaller, junior," figuratively "inferior, less important,"- (

The attachments of the rotator cuff muscles on the humerus

By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below) Bartleby.com: Gray's Anatomy, Plate 208, Public Domain, https://commons.wikimedia.org/w/index.php?curid=327860

Attachment and Innervation for Infraspinatus

Attachment & Innervations: Infraspinatus

Attachment and Innervation for Teres Minor

The brachial plexus with the nerves of the shoulder muscles labeled 

Attachment & Innervation: Teres Minor

Relative Location

The attachment of the rotator cuff muscles on the humerus

Where are the Infraspinatus and Teres Minor Located

Palpation

Cadaver dissection of the shoulder, highlighting the rotator cuff muscles

Palpating the External Rotator Cuff Muscles

Introduction to the External Rotator Cuff Muscles

Actions

 Both the infraspinatus and teres minor externally rotate the shoulder (with the arm in any position) and stabilize the humeral head in the glenoid fossa (8, 10, 11).

 sharing part of their names and a similar origin on the axillary border of the scapula, the teres minor has not been found to contribute to shoulder adduction. Further note, that the teres minor does external rotation, whereas the 

Cadaver dissection of the supraspinatus, infraspinatus, and teres minor

Supraspinatus, infraspinatus, teres minor and teres major - cadaver dissection - http://www.rvuanatomy.com/uploads/1/3/4/5/13457421/s2_animated.gif

The infraspinatus and teres minor may work synergistically with the posterior head of the deltoid to externally rotate the shoulder.

The infraspinatus and teres minor, as part of the rotator cuff work synergistically with the 

 to dynamically stabilize the glenohumeral joint.

Image of the rotator cuff muscles attaching into the glenohumeral joint

Arthrokinematics

The infraspinatus muscle on the posterior side of the scapula

Infraspinatus and Teres Minor Actions

Fascial Integration

My Fascial Hypothesis: Large fascial sheaths not only play a role in the transmission of mechanical force but may also play a role in dictating the function of muscular synergies. This is likely caused by reducing or increasing tone of invested musculature via reflex arcs formed between mechanoreceptors embedded in the connective tissue and the attached musculature. In this way, my view of fascia differs slightly from noted expert on the subject Tom Myers. I think of these large fascial sheaths (specifically the thoracolumbar fascia, iliotibial band, and abdominal fascial sheath) as nature's “motherboard.” A place for mechanical information to be communicated to the nervous system for more efficient recruitment of the muscular system. Despite having a slightly different philosophy it does not change the fact that fascia plays an important communicative role in the human body and we have Tom Myers to thank for his work.

Image of the fascial system of the body connecting muscles

 The fascia covering the infraspinatus is known simply as the "infraspinatus fascia" and is quite substantial, providing some of the origins of the infraspinatus. Although the fascia is tacked firmly to the borders of the scapula, encompassing the teres minor and infraspinatus (running under the deltoid and separating the teres minor from the 

), layers of the fascia do run continuous with the deltoid fascia laterally and blend with the fascia of the rhomboids medially (25, 26). This may imply a synergistic relationship between the rhomboids, external rotators, and deltoids. Although these muscles do not contract concentrically in synergy during elevation of the arm, the rhomboids and external rotators of the shoulder must play a stabilizing role with the deltoids concentrically. This synergy is covered by Tom Myers in reference to the Deep Back Arm Line (DBAL) and Superficial Back Arm Line (SBAL) (6). Further consideration, may also be given to the complex fascial network of the cervicothoracic junction. The continuous fascia from infraspinatus to the rhomboids to the thoracic spine, in conjunction with the more superficial fascia from deltoid, to trapezius to thoracic spine may give inference to the interdependence of glenohumeral joint motion, scapular motion, and thoracic mobility. I have often wondered if this facial network may be as imperative to optimal motion of the upper extremity as the thoracolumbar fascia is to optimal motion of the core and proximal lower extremity.

Note the infraspinatus fascia has been cut into and a flap pulled from the underlying muscle.

 Both the infraspinatus and teres minor not only have adjacent insertions on the periosteum of the greater tubercle but blend with the posterior shoulder capsule. This may imply fascial synergy with all muscles whose insertion blends and invest in the shoulder capsule, including the 

, as well as, the long head of the biceps brachii, long head of the triceps brachii, and 

 (21). Again this may imply facial synergy with this group of muscles that enhance the rigidity of various portions of the shoulder capsule depending on the motion of the humerus. More research is needed.

The deep back arm line of the body, including the infraspinatus

Tom Myers, Anatomy Trains: Second Edition. © Elsevier Limited 2009

Behavior in Postural Dysfunction

 based on their contribution to osteokinematic motion and commonly seen compensations related to 

 (glenohumeral internal rotation); however, research related to alterations in arthrokinematic motion related to shoulder pathology imply that these muscles may also have a propensity to become 

 present with limitations in shoulder flexion and abduction and a resting posture that includes excessive humeral internal rotation (1, 2). This would imply that the infraspinatus and teres minor were lengthened and under-active, and that activation and strengthening techniques may improve posture and motion. Strengthening techniques for the shoulder external rotators are common, as comparative studies of various external rotator strengthening techniques can be seen in studies by Lawrence et al., (18), Ha et al. (19), Reinold et al. (20). Further, some evidence suggests synergistic dominance and trigger point development in the posterior deltoid (23), which may further imply infraspinatus and teres minor inhibition adding congruence to the "long and under-active hypothesis". The Ha et al. study (19), even aimed to determine the external rotator activation technique that resulted in the least amount of posterior deltoid activity.

The effect pain and dysfunction have on arthrokinematics and the activity of the infraspinatus and teres minor may imply opposite changes in length and activity (short and over-active). In a study by Lawrence et. al. (18), pain and dysfunction did not result in superior glide (which is commonly thought of as a component of shoulder impingement syndrome), but an increase in anterior glide during flexion and inferior glide during abduction. Further, Neumann notes that tightness in the posterior capsule of the shoulder may result in anterior translation of the humeral head (3). Based on fiber direction and EMG studies the infraspinatus and teres minor contribute to inferior glide (3, 16), and via their insertion into the joint capsule may contribute to tightness in the posterior shoulder capsule. This would imply adaptive shortening and an increase in activity as a result of compensation. Further, in a study by Scovazzo et al. (17), swimmers with painful shoulders showed an increase in infraspinatus activity during "pull-through" when compared to those swimmers without shoulder pain. The only potential opposition to the infraspinatus and teres minor contributing to inferior glide and anterior translation (and adaptive shortening and over-activity) is their placement posterior to the humerus and insertion into the greater tubercle itself, and a "wedge effect" on the glenoid fossa, alluded to only by Basmaijian and Luca (24) that would result in anterior and superior translatory forces. Unfortunately, no research could be found on the direct effect of the infraspinatus and teres minor activity on arthrokinematics.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

 the infraspinatus and teres minor play no significant role.

, it is my hypothesis that most individuals will exhibit signs that imply the infraspinatus and teres minor are 

, but as compensation and changes in upper extremity motion progress to pain and pathology the infraspinatus and teres minor become 

 as a result of pattern overload, overuse and potentially an attempt to stabilize for arthrokinematic dyskinesis. This implies that most individuals will benefit from activation, integration, and strengthening techniques for the infraspinatus, but some individuals with a painful shoulder will benefit from a "staging" of intervention that starts with release and lengthening techniques. Once more normal tone is achieved, progression to activation and integration techniques will aid in optimizing posture and motion and reduce the chance of recurrence. Licensed professionals (PT, ATC, DC, OT, DO) may also find that manual shoulder mobilization techniques are helpful in normalizing tone and function of these muscles (videos below).

Shoulder impingement syndrome (anterior and posterior)

Teres minor and infraspinatus trigger points

Neck pain resulting from scapular dyskinesis

Signs of Altered Length/Tension and Tone:

 - Bottom Arm Restricted (Adduction and Internal Rotation)

Infraspinatus and Teres Minor Trigger Points :

Palpation results in tenderness and may result in radiating symptoms.

"We agree with most other authors that when myofascial pain is referred to the shoulder joint, the infraspinatus, supraspinatus, and sometimes the levator scapulae muscles are its most likely muscular sources (8, 25)".

The teres minor does not often result in radiating symptoms down the arm, but rather a very focal referral point over the region of the posterior deltoid (8).

Common trigger points of the teres minor muscle

Teres Minor Trigger Points - David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens

Common trigger points of the infraspinatus muscle

Infraspinatus Trigger Points - David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens

Postural Dysfunction and the External Rotator Cuff Muscles

Techniques and Ending Info

Chest Out/Thumbs Out

External Rotation Progression at 90° of Flexion with Scapular Stabilization

Deep Cervical Flexor Activation and External Rotator Activation

External Rotator Facilitation Taping

Posterior Shoulder (Self-Administered) Release Technique

Sleeper's Stretch

Modified Sleeper's Stretch (Brookbush Institute preferred method)

Self-administered Shoulder Mobilization

Exercises and Techniques for the Infraspinatus and Teres Minor

Phillip Page, Clare Frank, Robert Lardner, 

Assessment and Treatment of Muscle Imbalance: The Janda Approach

NASM Essentials of Corrective Exercise Training

NASM Essentials of Personal Training: 4th Edition

Diagnoses and Treatment of Movement Impairment Syndromes,

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani

Manipulative Therapy: Musuloskeletal Medicine

Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004

Inman VT, Saunders JB, Abbot JC, Observatinos on the function of the shoulder joint. J Bone Joint Surg 26:1 - 30, 1944

Scovazzo, M.L., Browne, A., Pink, M., Jobe, F.W., and Kerrigan, J. (1991). The painful shoulder during freestyle swimming: An electromyographic cinematographic analysis of twelve muscles. 

Lawrence, R.L., Braman, J.P., Staker, J.L., Laprade, R.F., Ludewig, P.M. (2014) Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, Part 2: Glenohumeral joint. 

Journal of Orthopaedic & Sports Physical Therapy

Ha, S., Kwon, O., Cynn, H., Lee, W., Kim, S., Park, K. (2013). Selective activation of the infraspinatus muscle. 

Reinold MM, Wilk KE, Fleisig GS, Zheng N, Barrentine SW, Chmielewski T, Cody RC, Jameson GG, Andrews JR. Electromyographic Analysis of the Rotator Cuff and Deltoid Musculature During Common Shoulder External Rotation Exercises. J Orthop Sports Phys Ther. 2004 Jul;34(7):385-94

Tubbs RS, Shoja MM, Shokouhi G, Loukas M, Oakes WJ. Insertion of the pectoralis major into the shoulder joint capsule. Anat Sci Int. 2008 Dec;83(4):291-3

Wang HK, Cochorane T. 2001. Mobility impairment, muscle imbalance, muscle weakness, scapular asymmetry and shoulder injury in elite volleyball athletes. J Sport Med Phys Fitness 41(3): 403-10

José Miota Ibarra, Hong-You Ge, Chao Wang, Vicente Martínez Vizcaíno, Thomas Graven-Nielsen, Lars Arendt-Nielsen. Latent Myofascial Trigger Points are Associated With an Increased Antagonistic Muscle Activity During Agonist Muscle Contraction. The Journal of Pain, Volume 12, Issue 12, December 2011, Pages 1282–1288

John V. Basmajian, Carlo J. De Luca. Muscles Alive: Their Function Revealed by ElectroMyography. 1985

Moccia D, Nackashi AA, Schilling R, Ward PJ. (2016). Fascial bundles of the infraspinatus fascia: anatomy, function, and clinical considerations. 

Chafik D, Galatz LM, Keener JD, Kim HM, Yamaguchi K. (2013). Teres minor muscle and related anatomy. 

Bibliography

Questions, comments, and criticisms are welcome and encouraged

Infraspinatus and Teres Minor

Related Courses:

Course Description: Infraspinatus and Teres Minor

Introduction to the External Rotator Cuff Muscles
4 Sub Sections

Infraspinatus and Teres Minor Actions
1 Sub Section

Fascial Integration

Postural Dysfunction and the External Rotator Cuff Muscles

Exercises and Techniques for the Infraspinatus and Teres Minor
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Bibliography

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Comments

Guest

Infraspinatus and Teres Minor

Related Courses:

Course Description: Infraspinatus and Teres Minor

Introduction to the External Rotator Cuff Muscles4 Sub Sections

Infraspinatus and Teres Minor Actions1 Sub Section

Fascial Integration

Postural Dysfunction and the External Rotator Cuff Muscles

Exercises and Techniques for the Infraspinatus and Teres Minor8 Sub Sections

Bibliography

Related Courses:

Comments

Guest

Introduction to the External Rotator Cuff Muscles
4 Sub Sections

Infraspinatus and Teres Minor Actions
1 Sub Section

Exercises and Techniques for the Infraspinatus and Teres Minor
8 Sub Sections