Teres Major Trigger Points

Introduction

The teres major is a deep shoulder muscle responsible for arm adduction, internal rotation, and extension. When trigger points develop in this muscle, they can cause posterior shoulder pain, upper arm tightness, and restricted movement, often mimicking rotator cuff dysfunction, shoulder impingement, or latissimus dorsi tightness.

Name and Area

  • Name: Teres Major

  • Area: Located in the posterior shoulder, running from the inferior angle of the scapula to the humerus (upper arm bone).

Indications

Teres major trigger points may contribute to:

  • Pain in the Back of the Shoulder and Upper Arm (Mistaken for Rotator Cuff Tendinitis or Shoulder Bursitis)

  • Pain That Extends to the Triceps and Outer Shoulder (Can Mimic Triceps Tendinitis or Nerve Compression)

  • Weakness in Shoulder and Arm Movements (Difficulty with Pulling, Pushing, or Lifting Movements)

  • Limited Shoulder Rotation and Extension (Difficulty Reaching Behind the Back or Performing Overhead Movements)

  • Pain That Worsens with Repetitive Shoulder Movements (Common in Swimmers, Climbers, and Weightlifters)

  • Stiffness in the Shoulder That Feels Like a "Pulled Muscle" or "Tight Band"

Pain from this muscle is often mistaken for rotator cuff injuries, latissimus dorsi tightness, or nerve compression syndromes.

Muscle Action

  • Internally Rotates the Shoulder: Turns the arm inward, essential for throwing, swimming, and lifting.

  • Extends the Shoulder: Moves the arm backward, important for pulling movements and stabilizing the shoulder.

  • Adducts the Arm: Brings the arm toward the body, supporting pushing and pulling actions.

The teres major is crucial for upper limb stability, scapular function, and shoulder mobility.

Signs and Symptoms

Individuals with teres major trigger points often report:

  • Pain in the Back of the Shoulder That Feels Like a "Dull Ache" or "Deep Knot"

  • Pain That Extends to the Upper Arm and Triceps, Worsens with Shoulder Movements

  • Limited Shoulder Mobility, Especially in Reaching Overhead or Behind the Back

  • Pain or Weakness When Performing Pulling Movements (Rows, Pull-Ups, or Rock Climbing)

  • Tightness in the Upper Arm That Feels Like a "Strain" or "Restricted Movement"

  • Pain That Worsens with Heavy Lifting, Throwing, or Swimming

Pain worsens with excessive shoulder use, poor posture, or prolonged arm movements.

Perpetuating Factors

Common causes of teres major trigger points include:

  • Repetitive Pulling and Lifting Movements (Common in Weightlifters, Rowers, and Rock Climbers)

  • Poor Shoulder Posture (Forward Shoulder Position Can Overload the Teres Major)

  • Weak or Imbalanced Rotator Cuff Muscles (Can Cause Overuse of the Teres Major for Shoulder Stability)

  • Sleeping With the Arm Overhead or Across the Chest (Can Lead to Chronic Shoulder Tightness)

  • Previous Shoulder Injuries (Can Lead to Restricted Shoulder Mobility and Muscle Imbalances)

Trigger Point Referral Pattern

Trigger points in the teres major refer pain to:

  • The posterior shoulder and upper arm (Can Mimic Rotator Cuff Dysfunction or Triceps Pain)

  • The outer shoulder and lateral arm (Mistaken for Shoulder Impingement or Nerve Irritation)

  • The mid-back near the scapula (Can Resemble Latissimus Dorsi Tightness or Postural Strain)

Pain from this muscle is often confused with rotator cuff injuries, latissimus dorsi dysfunction, or shoulder impingement syndrome.

Differential Diagnosis

Teres major trigger points may be mistaken for:

  • Rotator Cuff Dysfunction (Shoulder Pain and Weakness, Often Worsens With Overhead Movements or Lifting)

  • Latissimus Dorsi Tightness (Posterior Shoulder and Upper Back Pain, Affects Pulling Strength and Overhead Mobility)

  • Triceps Tendinitis (Pain in the Posterior Shoulder and Upper Arm, Worsens With Pressing Movements or Push-Ups)

  • Biceps Tendinitis (Pain in the Front of the Shoulder, Worsens With Lifting and Repetitive Shoulder Use)

  • Nerve Compression in the Shoulder (Radial or Axillary Nerve Entrapment, Can Cause Arm Weakness and Numbness)

A thorough shoulder, scapular, and upper limb examination is necessary to rule out these conditions.

Associated Trigger Points

Teres major trigger points often co-exist with:

  • Latissimus Dorsi (Shoulder and Upper Arm Pain, Affects Pulling Strength and Stability)

  • Infraspinatus (Posterior Shoulder and Rotator Cuff Pain, Common in Overhead Athletes and Weightlifters)

  • Upper Trapezius (Neck and Shoulder Tension, Can Contribute to Postural Strain and Shoulder Dysfunction)

  • Rhomboids (Scapular and Upper Back Pain, Common in Those with Poor Shoulder Posture and Weak Back Muscles)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Teres Major Inferior angle of the scapula Medial lip of the intertubercular sulcus of the humerus Lower subscapular nerve (C5–C7)

The teres major is innervated by the lower subscapular nerve (C5–C7), which also controls shoulder movement, arm rotation, and upper limb stability.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the posterior shoulder and lateral scapular border.

  • Resisted Shoulder Internal Rotation and Adduction Testing: Assess pain and weakness when rotating the arm inward or pulling the arm toward the body against resistance.

  • Scapular Mobility Testing: Look for restricted movement, scapular winging, or compensatory shoulder mechanics.

  • Shoulder Joint and Rotator Cuff Stability Testing: Rule out impingement, tendon injuries, or capsular restrictions.

Corrective Actions

Dry Needling

  • Dry needling can release trigger points in the teres major, reducing shoulder tightness and improving mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the teres major and posterior shoulder.

  • Myofascial Release: Helps improve circulation and reduce muscle tension in the shoulder girdle.

Stretching

  • Cross-Body Shoulder Stretch: Helps release tension in the teres major and improve shoulder flexibility.

  • Lat and Shoulder Stretch (Doorway Stretch): Opens the chest and lengthens the teres major and lats.

Strengthening Exercises

  • Band-Resisted Internal Rotation: Strengthens the teres major and improves shoulder function.

  • Single-Arm Dumbbell Rows: Helps balance the back muscles and improve scapular stability.

  • Face Pulls: Encourages proper shoulder mechanics and reduces overuse of the teres major.

Postural and Movement Adjustments

  • Avoid Overloading the Teres Major Without Strengthening the Opposing Muscles (Ensure Balanced Shoulder Training)

  • Improve Shoulder Mobility Before Strength Training (Prevents Overuse and Compensatory Movements)

  • Use Proper Lifting Mechanics (Engage the Rotator Cuff and Scapular Stabilizers to Reduce Strain on the Teres Major)

Conclusion

The teres major plays a crucial role in shoulder movement, arm stabilization, and upper limb function, but trigger points in this muscle can cause significant posterior shoulder, upper arm, and scapular pain. By incorporating dry needling, manual therapy, stretching, and strengthening exercises, individuals can reduce pain, improve mobility, and prevent chronic shoulder dysfunction.

➡️ Learn more about Trigger Points

➡️ Explore our Trigger Point Index

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.