Infraspinatus and Teres Minor Static Manual Release (Soft Tissue Mobilization)

Differentiation

1. The infraspinatus is a superficial muscle on the posterior surface of the scapula.
2. With your patient in prone, outline a triangle formed by the vertebral border of the scapula, the lateral border of the scapula, and the spine of the scapula.
3. Within this triangle is the infraspinous fossa; the infraspinatus fills the fossa with horizontally oriented fascicles that converge into a tendon at the top of the crease of the axilla (posterior humeral head).
4. Immediately caudal/inferior to the tendon of the infraspinatus is the "tube-shaped" teres minor .
5. If the teres minor is palpated along its length, the distal attachment joins the infraspinatus tendon, and the proximal attachment ends at the lateral border of the scapula.

Potentially Sensitive Tissues

• If this palpation is done with the patient in prone, and the muscles are approached from the posterior side of the scapula, then the risk of applying pressure to sensitive structures is minimal.

Trigger Points

• The most common trigger points for the infraspinatus are along the spine of the scapula near the medial border of the scapula.
• The most common trigger points for the teres minor are in the middle of the muscle, just medial the apex of the axillary crease.

Release Technique

1. This technique is most comfortable with the patient lying in prone and the practitioner standing on the affected side.
2. The practitioner can then use both hands to identify the medial border, lateral border, and spine of the scapula.
3. Use a thumb to strum the horizontal bumps of fibers of the infraspinatus in a superior to inferior direction with the intent of identifying taut/tender bands.
4. Once a taut band is located, the length of the band is explored for a dense nodule and consistent pressure is applied. Generally, some inferior to superior and/or medial to lateral pressure will aid in "pinning" the nodule.
5. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).

Teres Minor

1. To address teres minor trigger points, use the infraspinatus as a reference, tracing the muscle to its tendon, and then move the thumb just inferior/caudal to that tendon.
2. This "tube-shaped" muscle may be identified, running parallel to the infraspinatus tendon, near the apex of the axilla.
3. The length of the muscle may be explored for dense nodules; generally, these nodules occur in the middle of the muscle belly. Some proximal to distal (mostly inferior to superior) force may aid in "pinning" the nodule.
4. Consistent pressure is held until the nodule softens under the practitioner's fingers, or tissue density/sensitivity is significantly reduced (generally 30 - 120 seconds).