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Infraspinatus and Teres Minor Audio

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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This course describes the anatomy and integrated function of the infraspinatus and teres minor of the rotator cuff muscles (a.k.a. the shoulder external rotators, glenohumeral joint rotators, or SITS muscles). As the name implies, the infraspinatus originates inferior to the spine of the scapula in the infraspinous fossa of the scapula (shoulder blade), and the teres minor muscle is the smaller of two "teres muscles", the other being the "

." The teres minor originates superior to the teres major on the superior 2/3rd of the lateral border of the scapula. Both the infraspinatus and teres minor cross the glenohumeral joint (shoulder joint), and both tendons insert into the greater tubercle of the humerus. The fascia covering the infraspinatus is known as the "infraspinatus fascia." Although the fascia is tacked firmly to the borders of the scapula, medially it continues to invest in the fascia superficial to the rhomboids, superiorly it invests in the fascia superficial to the 

), and laterally layers envelop the teres minor (coursing under the deltoid and separating the teres minor from the 

), as well as more superficial layers coursing into the deltoid fascia. Research suggests the infraspinatus and teres minor are moderately sized muscle groups, contributing to approximately 5.9% (4.8% infraspinatus and 1.1% teres minor) of the total upper body muscle mass (for comparison, the 

 contributes approximately 10% of the upper body mass). Additionally, research suggests that the infraspinatus and teres minor are composed primarily of type II muscle fibers.

The infraspinatus and teres minor muscles both cross the shoulder (glenohumeral) joint and are likely the prime movers of shoulder external rotation. Additionally, both muscles aid in the stabilization of the shoulder during all joint actions as part of the rotator cuff. This course also discusses the contribution of the infraspinatus and teres minor to shoulder joint arthrokinematics, fascial integration, subsystem integration, and postural dysfunction. For example, "

 is correlated with altered rotator cuff recruitment and extensibility, including a reduction in EMG activity, a reduction in range of motion (ROM), and a reduction in shoulder stability, strength, and power. These changes imply these muscles most often should be 

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. For example, altered activity and length of the infraspinatus and teres minor may contribute to rotator cuff injury, rotator cuff tears, shoulder pain, shoulder impingement syndrome (SIS), supraspinatus tendon strain, biceps tendon impingement, and the resulting weakness and pain during motions such as shoulder abduction and flexion. Altered infraspinatus and teres minor activity is also correlated with an increase in supraspinatus and subscapularis activity. These changes in shoulder function are likely to result in a significant reduction in upper extremity speed, agility, and strength, and a reduction in the effectiveness of resistance training intended to improve upper body strength and hypertrophy (bodybuilding). Deeper knowledge of infraspinatus and teres minor anatomy is essential for optimal assessment, intervention selection, and building a repertoire of infraspinatus-specific techniques.

This course also provides detailed descriptions of etymology, attachments, innervations, joint actions, location, palpation, integrated actions, arthrokinematics, fascial integration, subsystem integration, postural dysfunction, assessment, clinical implications, and interventions.

Sample Intervention: Loss of Shoulder Range of Motion

: "Weak" or "with Compensation" (abduction)

Shoulder External Rotation Isolated Activation

Shoulder External Rotation Isolated Activation Progression

Squat to Row (Posterior Oblique Subsystem)

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 Summary: Infraspinatus and Teres Minor

Webinar

 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. (

An image of the rotator cuff muscles and shoulder joint 

https://upload.wikimedia.org/wikipedia/commons/thumb/f/fc/Shoulder_joint.svg/402px-Shoulder_joint.svg.png

 word-forming element meaning "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,"- (

Etymology of Terms Related to the Infraspinatus

 The proximal attachment invests in the medial 2/3 of the infraspinous fossa of the scapula, and to the adjacent fascia (1, 2).

 The distal attachment invests in the middle facet of the greater tubercle of the humerus and shoulder joint capsule superiorly and posteriorly (1, 2).

 This muscle is innervated by the suprascapular nerve, arising from the upper trunk of the brachial plexus via the ventral rami of nerve roots C5 and C6, and occasionally C4 (1, 2).

The suprascapular nerve passes through the scapular notch, underneath the transverse ligament, innervating the 

 before wrapping around the lateral border of the spine of the scapula and innervating the infraspinatus. Both the scapular notch and lateral border of the spine of the scapula may be sites of entrapment.

Infraspinatus Relative Size and Muscle Fiber Type:

The infraspinatus is a moderately sized muscle, contributing approximately 4.8% of the total muscle mass of the muscles in the upper body. In comparison, the pectoralis major muscle contributes approximately 10.7% (3).

Two studies demonstrate that the infraspinatus is primarily type 2 muscle fiber, and is composed of about 55% of type 2 muscle fibers (4, 5).

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 Innervations: Infraspinatus

 The proximal attachment invests in the upper 2/3rds of the dorsal surface of the lateral border of the scapula, and to the aponeurosis separating this muscle from the teres major and infraspinatus (1, 2).

 The distal attachment invests in the lowest facet of the greater tubercle of the humerus and shoulder joint posterior capsule (1, 2).

 This muscle is innervated by the axillary nerve, arising from the posterior cord (from the upper trunk, posterior division) of the brachial plexus via the ventral rami of nerve roots C5 and C6 (2).

The axillary nerve emerges from the posterior cord of the brachial plexus, descending just anterior to the subscapularis before winding back up through the quadrangular space and innervating the teres minor, long head of the triceps brachii, and deltoid.

Teres Minor Relative Size and Muscle Fiber Type:

The teres minor is a relatively small muscle, contributing approximately 1.1% of the total muscle mass of the muscles in the upper body. In comparison, the pectoralis major muscle contributes approximately 10.7% (3).

One study demonstrated that the teres minor exhibits a fairly even percentage of type I (49%) and type II (51%) muscle fibers (4).

The brachial plexus with the nerves of the shoulder muscles labeled 

By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below) Bartleby.com: Gray's Anatomy, Plate 807, Public Domain, https://commons.wikimedia.org/w/index.php?curid=541662

Attachment and Innervation: Teres Minor

The infraspinatus originates from the infraspinous fossa, which includes most of the posterior surface of the scapula inferior to the spine of the scapula (see the image below). The infraspinatus is encased in its own fascial compartment covered by the "infraspinatus fascia." Although the fascia attaches firmly to the spine and borders of the scapula, medially it continues to invest in the fascia superficial to the rhomboids, superiorly it invests in the fascia superficial to the 

), and laterally layers envelop both the teres minor (running under the deltoid and separating the teres minor from the 

), as well as courses continuous with the deltoid fascia. Additionally, the 

 is superior to the medial portion of the infraspinatus, and the 

 covers the distal portion and tendon. However, most of the infraspinatus is superficial, only covered by fascia and skin, and may be visible on lean individuals. The superior border of the infraspinatus abuts the spine of the scapula, and the medial border abuts the insertion of the 

. The superior-lateral border abuts the origin of the teres minor, and the inferior-lateral border abuts the origin of the teres major near the inferior angle of the scapula. Deep to the infraspinatus are its blood supply (suprascapular and circumflex scapular arteries) and nerve (suprascapular nerve).

The teres minor is also a relatively superficial muscle, although it is obscured by a complicated network of muscles and fascia around the axilla. The medial border of the teres minor blends with the infraspinatus, hinting at their common function and level of activity during shoulder motion (flexion, abduction, scaption) (1, 2, 3). The inferior border of the teres minor is abutted by the 

; however, the teres minor and teres major are separated by the infraspinatus fascia. Although the teres minor is relatively superficial, with the majority only covered by fascia and skin, it can be a challenge to differentiate the teres minor from the infraspinatus and teres major. Deep to the teres minor is the floor of the axilla, and parts of the long head of the triceps tendon and teres major.

The distal tendon of the infraspinatus travels horizontally, just superior to the tendon of the teres minor; however, they do share fascial slips. The tendon inserts into the posterior capsule and middle facet of the greater tubercle (between the insertions of the teres minor and 

The tendon of the teres minor courses posterior to the tendon of the long head of the triceps, and the tendon of the teres major passes anterior to this tendon. Additionally, the teres minor is the superior border of the quadrangular space, and the teres major is the inferior border of the quadrangular space (see image below). The posterior circumflex humeral artery and axillary nerve pass through the quadrangular space, and the teres minor has been implicated in the entrapment of these structures, especially when the teres minor (and or major) exhibit signs of trigger point development. The teres minor tendon does share fascial slips with the infraspinatus tendon, investing into the posterior capsule and lower facet of the greater tubercle (inferior to the tendon of the infraspinatus).

Where are the Infraspinatus and Teres Minor Located?

Ask your partner to assume a prone position, with the humerus supported by the table and forearm hanging off the side of the table.

Locate the medial border of the scapula, the spine of the scapula, and the axillary border of the scapula. Lay a finger on each of these borders, making a triangle.

Within this triangle is the infraspinatus, and the horizontal fibers of this muscle may be strummed from superior to inferior or inferior to superior.

Asking your partner to alternate between shoulder external rotation and relaxation may help you feel the horizontal fibers as they contract and relax under your fingers.

Ask your partner to assume a prone position, with the humerus supported by the table and forearm hanging off the side of the table (same position as above).

Pincer grip the muscle mass at the lateral border of the scapula, and you will have the distal portion of the teres minor, 

Take the time to note there is more than one muscle within this handful of tissue by strumming superior to inferior. You will note little cylinders, or tubes, each one representing a different muscle.

The middle cylinder/tube is the teres minor.

Have your partner externally rotate their humerus and then relax, and you should feel the teres minor become more firm/dense than the remaining tissue in your pincer grip. (The 

 are internal rotators, and only the teres minor is an external rotator).

Asking your partner to alternate between shoulder external rotation and relaxation may help you feel the fibers as they contract and relax under your fingers.

Cadaver dissection of the shoulder, highlighting the rotator cuff muscles

By Anatomist90 - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17900187

Palpating the Infraspinatus and Teres Minor

The infraspinatus and teres minor will contribute to external rotation of the shoulder (1 - 3, 6).


 share a name and similar origins, they do not have similar joint actions. The teres 

 contributes to shoulder adduction, extension, and internal rotation, while the teres 

The infraspinatus and teres minor eccentrically decelerate internal rotation.

The infraspinatus and teres minor are rotator cuff muscles. They work synergistically with the 

 to stabilize the glenohumeral joint during all joint actions.

, infraspinatus, and teres minor are synergists during external rotation.

As part of the rotator cuff musculature, the infraspinatus, teres minor, 

 work synergistically to dynamically stabilize the glenohumeral joint.

Image of the rotator cuff muscles attaching into the glenohumeral joint

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

Joint Actions: Infraspinatus and Teres Minor 

Hypothesized Contribution of the Infraspinatus and Teres Minor to Shoulder Joint Arthrokinematics

The fiber direction of the infraspinatus and teres minor implies they may contribute to compression and inferior glide. A classic study by Inman et al. (7) demonstrated a linear increase in activity of the infraspinatus and teres minor during the first 120° of abduction, with a slight decrease from 120 - 180°. This increase in activity during abduction may support the hypothesis that the compressive forces imparted by this muscle are important for glenohumeral stabilization. Less clear is the impact of the infraspinatus and teres minor on anterior and posterior glide of the humeral head. Neumann et al. (1) noted that tightness in the posterior capsule of the shoulder may result in anterior translation of the humeral head. The infraspinatus and teres minor may contribute to tautness in the posterior capsule; however, their location posterior to the humerus and attachment to the greater tubercle on the anterior aspect of the humerus may imply they impart a posterior glide force. Dysfunction of the glenohumeral joint (e.g., shoulder impingement syndrome, shoulder pain, rotator cuff tears) has been correlated with under-activity of the infraspinatus and excessive internal rotation, anterior glide, and inferior glide of the humeral head. Unfortunately, dysfunction resulting in a combination of a decrease in infraspinatus and teres minor activity, an increase in anterior glide, and an increase in inferior glide does not aid in developing a conclusion regarding the contribution of these muscles to arthrokinematic dysfunction. However, it is likely reasonable to assume that a decrease in infraspinatus and teres minor activity is likely correlated with the increase in internal rotation that is observed in those exhibiting signs of rounded shoulder posture. Glenohumeral joint dysfunction may be identified during an 

." The analysis above and clinical observations suggest that signs of shoulder dysfunction should result in the assessment of infraspinatus and teres minor activity, as well as the assessment of glenohumeral joint stiffness and other signs correlated with 

. Altered teres minor and infraspinatus activity may imply that intervention selection should include infraspinatus and teres minor intended techniques, as well as the addition of shoulder mobility or stability techniques when altered stiffness is implied by movement assessment (e.g., subscapularis release, shoulder mobilization, crucifixion stretch, external rotator activation, etc.).

Author's Note: More on Glenohumeral Joint Arthrokinematics

Optimal arthrokinematics of the shoulder can be summarized as "slide opposite roll" with the intent of maintaining the humeral head center in the glenoid fossa. That is, ideally, abduction of the shoulder would involve a superior roll of the humeral head and inferior glide. Flexion would result in posterior spin and anterior translation that should be accompanied by posterior glide. Internal rotation of the shoulder is accompanied by anterior roll and posterior glide. It is worth noting, that there is more to these opposing translatory forces than simply overcoming the roll that accompanies osteokinematic motion (flexion, abduction, internal rotation, etc.). All muscles create not only osteokinematic motions but may create force vectors that exaggerate the translation of the humeral head. For example, the deltoid not only creates a force on the humerus that results in abduction, but the fiber direction also pulls superiorly, contributing to superior glide and roll of the humeral head. The forces that help to maintain the humeral head center in the glenoid fossa are likely the result of resistance to stretch from passive structures and active resistance via co-contraction of the functional antagonists. The passive structures involved in providing an opposing translatory force include the joint capsule and ligaments, as well as the tonicity of muscles not actively involved in the joint motion (for example, the 

 may assist in creating an inferior force, opposing the superior role noted during abduction due to their inherent tone and passive resistance to stretch). The active resistance to translatory force is generally created by the co-contraction of antagonists proximal to the joint itself. This active resistance to translation is likely the primary role of the rotator cuff muscles, along with compression, to aid in glenohumeral stabilization. The rotator cuff may be viewed as tiny boosters attempting to maintain the humeral head in orbit (centered in the glenoid fossa) during functional activities throughout the large range of motion of the humeral head.

The infraspinatus muscle on the posterior side of the scapula

Arthrokinematics

Our understanding of fascia has benefited from an exponential increase in research over the past two decades. This includes research on its traditional functions as a passive medium that supports, protects, and encapsulates tissues (8) and its capacity to store elastic energy for explosive activity (9, 10). This also includes exciting new research that implicates fascia as a medium of communication. Levangin, H. hypothesized that this may occur via electrical, cellular, and/or mechanical signals (11). Histological studies have shown this tissue to be densely innervated by free 

 endings, as well as by Pacinian corpuscles and Ruffini endings (11, 12). This inspires consideration of fascia as a sensory organ with a strong link to motion and neuromuscular reflex. Further, Stecco et al. have demonstrated that deep fascia is arranged in layers that may 

 over one another (9). This finding is likely most responsible for inspiring various fascia-specific interventions and is most often referred to when describing fascia’s role in altering motion.

Fascia as a Passive Tissue (Traditional Functions):

Fascia as an Active Medium of Communication

 endings, Pacinian corpuscles, and Ruffini endings

May transmit the force of multiple muscles to aid in joint stabilization

Fibroblasts may play a role in increasing 

Image of the fascial system of the body connecting muscles

The fascia covering the infraspinatus is known as the "infraspinatus fascia" and is quite substantial, providing some of the origin of the infraspinatus. Although this fascia is attached firmly to the borders of the scapula, medially it continues to invest in the fascia superficial to the 

, superiorly it invests in the fascia superficial to the 

), as well as more superficial layers coursing into the deltoid fascia (13, 14). This may imply a synergistic relationship between the infraspinatus, teres minor, supraspinatus, rhomboids, and deltoids. Tom Myers also discusses this synergy of muscles in reference to the Deep Back Arm Line (DBAL) and Superficial Back Arm Line (SBAL) (12). The function of this synergy may be demonstrated when the 

 and supraspinatus concentrically contract during arm elevation (e.g. flexion, scaption, or abduction), while the infraspinatus and teres minor aid in shoulder stabilization (compression), and the rhomboids aid in scapular stabilization. Additional signs of this relationship may be that 

 often results in trigger point development in the infraspinatus, teres minor, rhomboids, supraspinatus, and posterior deltoid. Further research is needed to investigate the relationship between the deltoid fascia, infraspinatus fascia, rhomboid fascia, and cervicothoracic junction fascia, as this myofascial synergy has similarities to the relationship between the thoracolumbar fascia, gluteal fascia, and fascia lata.

The above is an illustration of the infraspinatus fascia with a flap resected to expose the infraspinatus.

The tendon of the infraspinatus is superior to the tendon of the teres minor; however, these adjacent tendons blend as they invest in the middle and lower facets of the greater tubercle and posterior capsule. This fascial continuity reinforces their shared function to externally rotate and stabilize the glenohumeral joint. Further, both muscles may contribute to compression and anterior translation of the humeral head. The infraspinatus tendon may also blend with the 

 tendon (another rotator cuff muscle), which invests in the superior facet of the greater tubercle and the superior capsule, and again alludes to the shared functionality of the rotator cuff muscles to compress and stabilize the glenohumeral joint. Additional research is needed to investigate a more complex myofascial synergy that would include the anterior and inferior fascial web created by the 

 tendon, superior and middle glenohumeral ligaments, coracohumeral ligaments, and the transverse humeral ligaments. Additionally, the long head of the biceps brachii, long head of the triceps brachii, and 

invest in this complex fascial network (13 - 15).

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

Fascial Integration

Summary Statement and Research Findings

Comparing EMG Activity in Healthy Individuals (Asymptomatic Participants)

Comparing EMG Activity With and Without Shoulder Pain

Infraspinatus and Teres Minor Research

Research demonstrates a relative decrease in the electromyographic (EMG) activity of the infraspinatus and teres minor in those exhibiting signs of 

 (19, 32, 48, 51, 53). Most shoulder dysfunction results in excessive shoulder internal rotation, suggesting these muscles likely adopt a relatively lengthened position (53, 55). These changes imply the infraspinatus and teres minor are "under-active and long" and should be addressed with activation and integration techniques. Note that it is not uncommon for individuals to exhibit a loss of shoulder internal rotation range of motion (ROM), which may imply that infraspinatus and teres minor release techniques may also be beneficial.

Under-activity is addressed with isolated activation and integration techniques.
 

Shoulder External Rotator Isolated Activation

Shoulder External Rotator Activation Progression

Combined Deep Cervical Flexor and External Rotator Activation

Manual Technique: Infraspinatus and Teres Minor Static Manual Release

Movement Impairment and Postural Dysfunction:

: The signs correlated with UBD include "arms fall" and "shoulder girdle elevation" during an 

, and potentially "trunk flexion" during an 

." Further, excessive shoulder internal rotation and scapula anterior tipping (rounded shoulder posture) may be identified during static posture. Generally, those exhibiting 

 also present with limitations in shoulder flexion, abduction, and external rotation (53, 55). 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.

Lumbo Pelvic Hip Complex Dysfunction (LPHCD)

: The infraspinatus and teres minor do not play a significant role.

Sacroiliac Joint Dysfunction (SIJD): The infraspinatus and teres minor do not play a significant role.

 The infraspinatus and teres minor do not play a significant role.

Shoulder impingement syndrome (SIS) (24, 45, 48, 50)

Teres minor and infraspinatus trigger points (53, 55)

Neck pain resulting from scapular dyskinesis

: Infraspinatus and teres minor under-active and long

Infraspinatus and Teres Minor

Related Courses:

Course Summary: Infraspinatus and Teres Minor

Webinar

Etymology of Terms Related to the Infraspinatus

Attachment and Innervations: Infraspinatus

Attachment and Innervation: Teres Minor

Where are the Infraspinatus and Teres Minor Located?

Palpating the Infraspinatus and Teres Minor

Joint Actions: Infraspinatus and Teres Minor

Arthrokinematics

Fascial Integration

Infraspinatus and Teres Minor Research
3 Sub Sections

Movement Impairment and the Infraspinatus and Teres Minor

Common Trigger Points and Referral Pain Patterns for the Infraspinatus and Teres Minor

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

Sample Intervention

Bibliography

Related Courses:

Comments

Guest

Infraspinatus and Teres Minor

Related Courses:

Course Summary: Infraspinatus and Teres Minor

Webinar

Etymology of Terms Related to the Infraspinatus

Attachment and Innervations: Infraspinatus

Attachment and Innervation: Teres Minor

Where are the Infraspinatus and Teres Minor Located?

Palpating the Infraspinatus and Teres Minor

Joint Actions: Infraspinatus and Teres Minor

Arthrokinematics

Fascial Integration

Infraspinatus and Teres Minor Research3 Sub Sections

Movement Impairment and the Infraspinatus and Teres Minor

Common Trigger Points and Referral Pain Patterns for the Infraspinatus and Teres Minor

Exercises and Techniques for the Infraspinatus and Teres Minor10 Sub Sections

Sample Intervention

Bibliography

Related Courses:

Comments

Guest

Infraspinatus and Teres Minor Research
3 Sub Sections

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