Anterior Shoulder Pain – The Common Culprit

By William Huhn.

Per Travell & Simons’

Myofascial Pain and Dysfunction

The Trigger Point Manual


We commonly treat (successfully) shoulder-pain issues, and the infraspinatus is almost always involved. In fact, I’d say over 95% of the time it IS involved.

Please take a moment to read what Travell and Simons have said about this muscle.

Perhaps you’ll recognize some of the symptoms they describe.


Please note – if TrPs are involved you MUST have them inactivated prior to exercising the rotator cuff muscles. Ignoring this crucial part of TP protocol will lead to perpetuation/exacerbation of your symptoms.


Infraspinatus TrP Symptoms

T&S Excerpt


“We agree with other authors that when myofascial pain is referred to the shoulder joint, the infraspinatus, supraspinatus, and sometimes the levator scapulae muscles are its most likely muscular sources.

Various patients with an infraspinatus TrP commonly complain: “I can’t reach into my back pants pocket; I can’t fasten my brassiere behind my back; I can’t zip up the back of my dress; I can’t get my sore arm into my coat sleeve last, but must put it in first; or I can’t reach back to the night stand beside my bed.” Inability to medially rotate and to adduct the arm at the glenohumeral joint simultaneously is a revealing sign of infraspinatus TrP activity. Patients are likely to complain that attempting to comb the hair or brush the teeth is painful. Tennis players complain that this shoulder pain limits the vigour of their strokes. 

Sola and Williams identified the symptoms of shoulder-girdle fatigue, weakness of grip, loss of mobility at the shoulder, and hyperhidrosis in the referred pain area as due to TrP activity in the infraspinatus muscle. 

Referred pain prevents the patient from lying on the painful side (and sometimes on the back) at night, because the weight of the thorax compresses and stimulates the infraspinatus TrPs.  When the patient lies on the pain-free side for relief, the uppermost arm is likely to fall forward and painfully stretch the affected infraspinatus muscle, again disturbing sleep. Thus, patients with very active infraspinatus TrPs may find that they can sleep only by propping themselves up, seated in a chair or on a sofa for the night. 

A major part of the shoulder-girdle pain associated with hemiplegia is commonly due to myofascial TrPs in the trapezius, scalene, supraspinatus, infraspinatus, and subscapularis muscles. In the absence of spasticity at rest, the TrPs in these muscles usually respond well to local treatment.” 


From Travell & Simons (1999)

Volume 1, Pg. 556