Teres ninor and major are the muscles that form a part of the shoulder’s rotator cuff. Pain in them is often experienced when a person outstretches his arm or stretches the arm forward to reach something.
The pressure point is at the backside of the upper arm.
The pain can be either burning, stinging, or numbing in the affected area. Teres major and minor are the commonly affected muscles in the shoulder, and most shoulder and back pain originates due to some problem such as a tear in these muscles.
Anatomy of Teres Minor and Teres Major
The teres minor muscle extends from the lateral border of the scapula and winds around the shoulder to be inserted into the greater tubercle of the humerus.1 It mediates the rotation of the shoulder laterally or externally.2
The teres major muscle is not actually a part of the rotator cuff muscles and spans from the inferior aspect of the scapula to the proximal part of the shaft of the humerus. It mediates the internal or medial rotation of the arm and stabilizes the shoulder joint.3
Both these muscles work together to carry about the rotational movements of the arm at the shoulder joint.
Trigger Points of Pain
A trigger point initiates pain in the area and also refers to the surrounding area. The main trigger or pain zone for teres major and minor pain is at the back of the shoulder. Any action that leads to excessive stretch at the trigger point can lead to pain that radiates from the side of the shoulder to the backside of the arm.
One such action is excessive force when throwing a baseball ball. Any inflammation, irritation, or injury can also lead to this pain.
What is Myofascial Syndrome?
As the name indicates, Myofascial syndrome is related to the muscles and fascia. It is, in fact, a chronic pain disorder characterized by pain that is activated by stimulation of a trigger point and can radiate to seemingly unrelated parts of the body. The trigger point may be felt as a small lump or knot in the muscle.
The point is an area of muscle stuck in the contracted state that isn’t receiving adequate oxygen supply due to the stoppage of blood flow. This sends out a pain signal.4
This type of pain syndrome is often misunderstood and overlooked. It can be confused with fibromyalgia which, in contrast to myofascial pain syndrome, is felt throughout the body.5 The common causes of the syndrome include:
- Muscle injury
- Repetitive use of muscles
- Poor posture
- Excess cold
- Psychological stress
- Entrapped nerve
This syndrome can affect any muscle group. The common symptoms include:
- Aching or throbbing pain
- Soreness or tenderness of muscles
- Restricted range of movement
Due to this, the quality of sleep and lifestyle can be affected.
Treatment of myofascial pain syndrome
The myofascial syndrome can be treated by both physiotherapy and the use of medications. Applying local heat or soaking in warm water may also prove beneficial. Some physiotherapy techniques include:
- Muscle strengthening exercises
- Massage
- Trigger point pressure release
- Active release techniques
Some medications that may prove helpful in treating myofascial syndrome:
- Analgesics (Pain-killer)
- Muscle relaxants
- Steroids
- Non-steroidal anti-inflammatory drugs
Nowadays, ultrasound and transcutaneous electrical nerve stimulation can be used with advancements in technology.6
Prognosis
Each person’s pain is different and requires a different duration of treatment. Pain can be triggered from time to time and can be long-lasting.
However, proper health care treatment can recover the pain completely.
Prevention
Myofascial pain can be prevented by ensuring proper sleep hygiene, reducing stress levels, doing regular exercise, avoiding muscle trauma or injury, practicing muscle relaxation techniques7, and eating a healthy diet.
Now that you know all about the teres major and minor pain, remember to use local heat if ever faced with sudden shoulder pain and consult an experienced health care provider for a proper remedy.
References:
- Jeno, Susan H., et al. “Anatomy, Shoulder and Upper Limb, Arm Supraspinatus Muscle.” StatPearls, StatPearls Publishing, 7 August 2021.
- McCausland, Cassidy, et al. “Anatomy, Shoulder and Upper Limb, Shoulder Muscles.” StatPearls, StatPearls Publishing, 13 August 2021.
- Iamsaard, Sitthichai et al. “Variant insertion of the teres major muscle.” Anatomy & cell biology vol. 45,3 (2012): 211-3. doi:10.5115/acb.2012.45.3.211
- Weed, N D. “When shoulder pain isn’t bursitis. The myofascial pain syndrome.” Postgraduate medicine vol. 74,3 (1983): 97-8, 101-2, 104. doi:10.1080/00325481.1983.11698416
- Yunus, M B et al. “Primary fibromyalgia syndrome and myofascial pain syndrome: clinical features and muscle pathology.” Archives of physical medicine and rehabilitation vol. 69,6 (1988): 451-4.
- Majlesi, Javid, and Halil Unalan. “Effect of treatment on trigger points.” Current pain and headache reports vol. 14,5 (2010): 353-60. doi:10.1007/s11916-010-0132-8
- Panta, Prashanth. “The Possible Role of Meditation in Myofascial Pain Syndrome: A New Hypothesis.” Indian journal of palliative care vol. 23,2 (2017): 180-187. doi:10.4103/0973-1075.204239
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.