Teres Minor Trigger Points

Introduction

The teres minor is a small but essential rotator cuff muscle responsible for shoulder external rotation, stabilization, and upper limb control. 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 infraspinatus strain.

Name and Area

  • Name: Teres Minor

  • Area: Located in the posterior shoulder, running from the lateral border of the scapula to the greater tubercle of the humerus.

Indications

Teres minor 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 Outer Shoulder and Forearm (Can Mimic Nerve Compression or Radial Nerve Pain)

  • Weakness in Shoulder External Rotation (Difficulty with Throwing, Reaching Back, or Overhead Movements)

  • Pain or Discomfort When Sleeping on the Affected Shoulder (Common in Side Sleepers and Athletes)

  • Limited Shoulder Mobility, Especially in External Rotation and Overhead Activities

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

Pain from this muscle is often mistaken for rotator cuff injuries, infraspinatus dysfunction, or nerve compression syndromes.

Muscle Action

  • Externally Rotates the Shoulder: Turns the arm outward, essential for throwing, racquet sports, and reaching behind the back.

  • Stabilizes the Shoulder Joint: Prevents excessive movement of the humeral head during arm motion.

The teres minor is crucial for shoulder stability, upper limb movement, and rotator cuff function.

Signs and Symptoms

Individuals with teres minor trigger points often report:

  • Pain in the Back of the Shoulder That Feels Like a "Burning" or "Tight" Sensation

  • Pain or Weakness When Rotating the Arm Outward (Common in Throwing or Lifting Movements)

  • Pain That Spreads to the Upper Arm and Forearm (Can Feel Like Nerve Pain or Muscle Fatigue)

  • Difficulty Reaching Behind the Back or Performing External Rotation Movements

  • Shoulder Clicking or Popping During Movement (May Indicate Rotator Cuff Dysfunction)

  • Pain That Worsens After Repetitive Shoulder Use or Overhead Activity

Pain worsens with excessive shoulder use, poor posture, or repetitive overhead movements.

Perpetuating Factors

Common causes of teres minor trigger points include:

  • Repetitive Overhead Movements (Common in Swimmers, Tennis Players, Baseball Pitchers, and Weightlifters)

  • Poor Shoulder Posture (Forward Shoulder Position Can Lead to Chronic Tightness and Overuse of the Teres Minor)

  • Weak or Imbalanced Rotator Cuff Muscles (Can Cause the Teres Minor to Overcompensate for Shoulder Stability)

  • Holding the Shoulder in a Fixed Position for Long Periods (Driving, Typing, or Carrying Heavy Bags)

  • Previous Shoulder Injuries (Can Lead to Rotator Cuff Weakness and Chronic Muscle Dysfunction)

Trigger Point Referral Pattern

Trigger points in the teres minor refer pain to:

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

  • The outer shoulder and lateral forearm (Mistaken for Radial Nerve Irritation or Tennis Elbow)

  • The upper back near the scapula (Can Resemble Infraspinatus or Latissimus Dorsi Tightness)

Pain from this muscle is often confused with rotator cuff impingement, nerve compression, or shoulder joint dysfunction.

Differential Diagnosis

Teres minor trigger points may be mistaken for:

  • Rotator Cuff Tear (Shoulder Pain and Weakness, Worsens with Overhead Movements or Lifting)

  • Shoulder Impingement Syndrome (Pain in the Shoulder That Increases with Overhead Activity or Repetitive Use)

  • Infraspinatus Dysfunction (Pain in the Posterior Shoulder and Weakness in External Rotation Movements)

  • Biceps Tendinitis (Pain in the Front of the Shoulder That Worsens with Lifting and Repetitive Motion)

  • Cervical Radiculopathy (Neck Pain That Radiates to the Shoulder and Arm, Due to Nerve Compression in the Cervical Spine)

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

Associated Trigger Points

Teres minor trigger points often co-exist with:

  • Infraspinatus (Posterior Shoulder and Arm Pain, Affects Shoulder Stability and External Rotation)

  • Latissimus Dorsi (Shoulder and Upper Arm Pain, Common in Overhead Athletes and Weightlifters)

  • Upper Trapezius (Neck and Shoulder Tension, Common in Postural Strain and Chronic Stress)

  • 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 Minor Lateral border of the scapula Greater tubercle of the humerus Axillary nerve (C5–C6)

The teres minor is innervated by the axillary nerve (C5–C6), 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 External Rotation Testing: Assess pain and weakness when rotating the arm outward 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 minor, reducing shoulder tightness and improving mobility.

Manual Therapy

  • Trigger Point Release: Apply deep sustained pressure to tight spots in the teres minor 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 minor and improve shoulder flexibility.

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

Strengthening Exercises

  • Resisted External Rotation with Bands: Strengthens the teres minor and improves shoulder function.

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

  • Prone Shoulder Extensions: Helps activate the rotator cuff without excessive strain.

Postural and Movement Adjustments

  • Avoid Overloading the Teres Minor 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 Minor)

Conclusion

The teres minor plays a crucial role in shoulder movement, rotator cuff stabilization, and arm 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.