Yatreyu: Created page with "'''Supraspinatus''' is the most superior of the four rotator cuff muscles, lying entirely within the supraspinous fossa of the scapula beneath the trapezius. Its trigger points (TrPs) produce a deep aching pain in the mid-deltoid region that extends variably down the arm, and — crucially — may concentrate at the lateral epicondyle of the elbow. This epicondylar referral is a characteristic that usefully separates supraspinatus from infraspinatus in the clinical histo..."

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Created page with "'''Supraspinatus''' is the most superior of the four rotator cuff muscles, lying entirely within the supraspinous fossa of the scapula beneath the trapezius. Its trigger points (TrPs) produce a deep aching pain in the mid-deltoid region that extends variably down the arm, and — crucially — may concentrate at the lateral epicondyle of the elbow. This epicondylar referral is a characteristic that usefully separates supraspinatus from infraspinatus in the clinical histo..."

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'''Supraspinatus''' is the most superior of the four rotator cuff muscles, lying entirely within the supraspinous fossa of the scapula beneath the trapezius. Its trigger points (TrPs) produce a deep aching pain in the mid-deltoid region that extends variably down the arm, and — crucially — may concentrate at the lateral epicondyle of the elbow. This epicondylar referral is a characteristic that usefully separates supraspinatus from infraspinatus in the clinical history. The supraspinatus is a major actor in the broad and diagnostically challenging landscape of shoulder pain: its TrPs are routinely mistaken for subdeltoid bursitis, subacromial bursitis, rotator cuff tear, supraspinatus tendinitis, and C5–C6 radiculopathy. It is seldom involved in isolation — almost always found in association with infraspinatus or upper trapezius TrPs. Because shoulder pain has an extensive physical examination and many muscles compete as sources, a careful subjective history targeted at discriminating features is the most efficient path to a focused examination.

== Anatomy ==

The supraspinatus arises from the medial two-thirds of the supraspinous fossa of the scapula and attaches '''laterally''' to the superior facet of the greater tubercle of the humerus. The tendon blends with the shoulder joint capsule to form the superior component of the rotator cuff, passing beneath the acromion and the coracoacromial ligament. The tendinous attachment has a relatively '''avascular zone''' that is particularly vulnerable to enthesopathy when subjected to sustained tension — chronic TrP tautness reduces local circulation, producing ischaemic hypoxia that can ultimately lead to calcific deposits at the insertion.

'''Primary actions:'''
* Abduction of the arm at the glenohumeral joint (working as a team with the middle deltoid throughout the full arc)
* Stabilisation of the humeral head in the glenoid fossa during arm use — including preventing downward displacement of the humerus when a weight is carried with the arm at the side
* Active during arm swing in walking (forward and backward, not at the ends of swing) — preventing humeral head dislocation

'''Innervation:''' Suprascapular nerve (C5), via the upper trunk of the brachial plexus.

'''Functional synergists:'''
* Abduction: middle deltoid
* Scapular rotation during arm elevation: upper trapezius, lower trapezius, serratus anterior, rhomboids
* Humeral head stabilisation: infraspinatus, teres minor, subscapularis (the other three rotator cuff muscles)

'''Functional antagonists:'''
* Adduction: latissimus dorsi, teres major, lower fibres of pectoralis major

'''Fatigue characteristics:''' The supraspinatus is the first shoulder muscle to show evidence of fatigue during sustained flexion or abduction to 90° — within a fraction of a minute. After 5 minutes, both amplitude and frequency changes on EMG indicate advancing fatigue. This early fatigability makes it especially vulnerable to overuse in positions demanding elevated arms.

== Referred Pain Patterns ==

'''Essential pain zone''' (present in nearly all patients with active TrPs):
* Deep ache in the mid-deltoid region — the lateral shoulder over the deltoid

'''Spillover pain zones''' (present in a proportion of patients):
* Down the lateral arm, often to the forearm
* '''Lateral epicondyle of the elbow''' — a concentration of pain at the epicondyle that does not occur with infraspinatus TrPs and is a useful differentiating feature
* Rarely to the wrist

'''Three tender regions''' corresponding to three TrP locations (see Trigger Point Examination below):
# Midfibre central TrP — in the belly of the supraspinous fossa
# Lateral trigger area — in the musculotendinous junction region, deep in the lateral supraspinous fossa just medial to the acromion
# Subacromial/humeral attachment region — where the tendon blends with the joint capsule beneath the acromion

== Activation and Perpetuating Factors ==

The supraspinatus is vulnerable to both '''sustained''' and '''repetitive''' overload, in contrast to the infraspinatus which is more likely activated by acute overload events:

* Carrying heavy objects (suitcase, briefcase, shopping bag, heavy camera equipment) with the arm hanging at the side — the muscle is continuously active preventing humeral head displacement
* Walking a large dog that pulls hard on the lead — sustained downward traction on the arm
* Lifting objects to or above shoulder height with the arm outstretched
* Work that demands repeated and/or prolonged elevation of the arms (welding, painting ceilings, hairdressing, dentistry, putting curlers in the hair)
* Activities requiring sustained arm abduction or flexion

Motor vehicle accidents activate supraspinatus TrPs in a slightly higher proportion of patients than infraspinatus TrPs — approximately 20–30% of patients experiencing their first motor vehicle accident develop active TrPs in the supraspinatus regardless of impact direction.

== Clinical Examination ==

=== Why the History Matters ===

Shoulder pain has one of the most extensive and time-consuming physical examination protocols in musculoskeletal practice. A thoughtful history that targets the specific discriminating features of each candidate muscle can make the physical examination far more efficient by guiding the clinician toward the most likely source before palpation begins. The following sections are structured to support that approach.

=== Subjective Presentation ===

The subjective profile of supraspinatus TrP pain has features that distinguish it from other shoulder pain sources, particularly from the closely related infraspinatus.

'''Cardinal subjective features:'''

{| class="wikitable"
|-
! Feature !! Detail
|-
| '''Pain location''' || Mid-deltoid region — lateral shoulder over the belly of the deltoid; the patient typically places the hand over the lateral deltoid, not the front of the shoulder
|-
| '''Quality''' || Deep dull ache; not a sharp or catching pain
|-
| '''Elbow component''' || Pain may concentrate at the '''lateral epicondyle''' — this is a characteristic feature not seen with infraspinatus TrPs and helps localise the source when the patient volunteers elbow pain alongside shoulder pain
|-
| '''Aggravating movement''' || Forceful abduction; overhead reaching; lifting objects with the arm outstretched at or above shoulder height
|-
| '''Sustained load aggravation''' || Carrying a heavy bag or briefcase with the arm at the side progressively worsens pain — the muscle contracts continuously to prevent humeral head descent
|-
| '''Sleep disturbance''' || Mild to moderate; aching at night; less severe than the bilateral sleep problem characteristic of infraspinatus TrPs
|-
| '''Functional complaints''' || Difficulty reaching overhead to comb hair, brush teeth, or shave (dominant side); may be unaware of moderate restriction on the non-dominant side because the dominant arm performs most overhead activities
|-
| '''Shoulder clicking/snapping''' || Some patients report clicking or snapping in the shoulder during movement — this disappears when supraspinatus TrPs are inactivated; likely caused by TrP tautness interfering with the normal glide of the humeral head in the glenoid fossa
|-
| '''Catching pain''' || Occasional sudden severe pain on a specific elevation movement ("catching"), relieved by returning the arm to neutral — a symptom of scapulohumeral muscle imbalance caused by TrP-induced incoordination; resolves with TrP treatment
|}

'''Key history questions that target supraspinatus specifically:'''

{| class="wikitable"
|-
! Question !! Significance
|-
| "Does your pain go to the elbow or feel like it is in the elbow?" || '''Positive for supraspinatus''' — lateral epicondyle referral does not occur with infraspinatus TrPs; a patient who reports both shoulder and elbow pain points strongly toward supraspinatus
|-
| "Where exactly does your shoulder hurt — front, top, or side?" || Supraspinatus: lateral (mid-deltoid); Infraspinatus: deep front of joint; Subscapularis: posterior shoulder; Deltoid: directly over the muscle belly
|-
| "Does carrying a heavy bag or briefcase make it worse?" || Yes → supraspinatus (sustained downward traction); less characteristic of infraspinatus (which is more activated by reaching backward)
|-
| "Does lifting overhead make it worse?" || Yes throughout the arc → supraspinatus; pain in a specific small arc → rotator cuff tear (evaluate urgently)
|-
| "Does your shoulder click or make a snapping noise?" || Supraspinatus TrP activity — inactivation of TrPs resolves the clicking; distinguish from labral click (localised pop with reproduction)
|-
| "Can you sleep on the painful shoulder?" || Infraspinatus: cannot sleep on either side; Supraspinatus alone: usually able to sleep with modification — rarely causes severe sleep-disturbing nocturnal pain in isolation
|-
| "Did it start after a specific incident, or gradually?" || Infraspinatus: typically acute onset, patient recalls exact event; Supraspinatus: typically gradual onset from sustained/repetitive loading
|-
| "Is it painful throughout lifting your arm, or just in the middle of the movement?" || Throughout the arc = supraspinatus TrP; pain only in a specific small arc = rotator cuff structural pathology — evaluate for tear
|}

'''Differential history features — supraspinatus vs the most important competitors:'''

{| class="wikitable"
|-
! Feature !! Supraspinatus !! Infraspinatus !! Subscapularis !! Subdeltoid bursitis
|-
| Pain location || Mid-deltoid (lateral) || Deep inside front of joint || Posterior shoulder; wrist referral || Lateral deltoid (more diffuse than TrP)
|-
| Elbow pain || '''Lateral epicondyle — characteristic''' || Absent || Absent || Absent
|-
| Sleep problem || Mild; can usually modify || Cannot sleep on either side; may sleep sitting up || Severe; all positions problematic || Varies; usually one side
|-
| Behind-the-back movement || Moderately restricted || '''Severely restricted''' (cannot reach pocket or brassiere hooks) || Restricted passively and actively || Variable
|-
| Overhead lifting || Pain throughout; heavy loads worsen || Less overhead-specific || Lateral rotation loss limits overhead || Painful arc; specific zone
|-
| Carrying a heavy bag || '''Progressive ache with sustained carry''' || Not characteristic || Not characteristic || Not characteristic
|-
| Clicking in shoulder || Common — resolves with TrP inactivation || Less typical || Uncommon || Uncommon
|-
| Onset pattern || Gradual; sustained/repetitive loading || '''Acute; specific incident recalled''' || Often gradual; frozen shoulder association || Variable
|}

=== Active Range of Motion ===

'''Mouth Wrap-around Test:'''
This test requires full active abduction and lateral rotation at the glenohumeral joint combined with normal scapular mobility (see [[Muscle:Levator_Scapulae#Mouth_Wrap-around_Test_(Shoulder_Girdle_Screen)|Mouth Wrap-around Test]]). It is restricted by supraspinatus TrPs.

'''Position-dependent findings:'''
* '''Upright position:''' The patient is unable to hold the arm fully abducted because this contracts the supraspinatus in the shortened position and compresses enthesopathy at the humeral attachment
* '''Supine position:''' The patient performs the Mouth Wrap-around Test with '''less difficulty''' than upright — because the muscle is not lifting the weight of the arm against gravity. This position-dependence of the restriction is clinically useful: improvement supine versus upright points toward supraspinatus enthesopathy rather than structural joint pathology

'''Pain pattern during abduction:'''
* '''Throughout the arc''' — characteristic of supraspinatus TrPs
* '''Only in a specific small arc of motion''' — evaluate urgently for rotator cuff tear; this arc finding is not characteristic of TrP-only involvement

'''Joint examination:'''
Scapular mobility should be assessed. Accessory joint movements (joint play) must be examined in the glenohumeral, acromioclavicular, and sternoclavicular joints — full arm range of motion depends on accessory movements at all three joints. The elbow complex should also be included given that supraspinatus commonly refers pain to that region.

=== Supraspinatus Trigger Point Examination ===

The supraspinatus must be palpated '''through the overlying trapezius muscle''' — this significantly affects technique and the reliability of some findings.

'''Three tender regions, each with distinct examination approaches:'''

==== 1. Midfibre Central TrP ====

'''Location:''' Just above the spine of the scapula, several centimetres (approximately 2.5–4 cm) lateral to the vertebral border of the scapula in the midregion of the muscle fibres.

'''Patient position:''' Seated comfortably, affected arm close to the body and relaxed. For less active TrPs, place the arm in the stretch position (behind the back at waist level) to increase TrP sensitivity.

'''Technique:''' Flat palpation directed through the trapezius downward into the supraspinous fossa. Sufficient pressure on an active TrP reproduces pain the patient recognises.

'''Local twitch response:''' Unreliably elicited by palpation and not always perceived by needle penetration — because the TrP lies beneath the trapezius. Do not use LTR absence to exclude TrP.

'''Palpation finding:''' Exquisite spot tenderness. In the middle portion of this deep muscle, central and attachment TrPs are not distinguishable by palpation alone.

==== 2. Lateral Trigger Area (Musculotendinous Junction) ====

'''Location:''' In the space between the spine of the scapula and the clavicle, just medial to the acromion, deep in the lateral supraspinous fossa.

'''Technique:''' Deep flat palpation in the space just medial to the acromion. This region is so deeply placed that '''firm palpation may reveal only minimal tenderness''' despite producing significant referred pain when needled — the depth of overlying tissue attenuates the palpation pressure.

'''Clinical note:''' The referred pain evoked by needling TrPs in this lateral area is often out of proportion to the slight tenderness elicited by surface palpation — a useful diagnostic observation. This tenderness most likely represents enthesopathy of the musculotendinous junction secondary to central TrP tension.

==== 3. Subacromial/Humeral Attachment Region ====

'''Location:''' The tendinous attachment of the supraspinatus to the head of the humerus, where the tendon blends with the joint capsule under the acromion.

'''Technique:''' Most easily palpated with the patient's hand placed behind the back at waist level to medially rotate the arm and bring the tendon out from beneath the acromion. Palpate directly beneath the acromial tip.

'''Findings:''' Often marked tenderness; may be indistinguishable from subacromial bursitis by palpation alone (see Differential Diagnosis). Early calcific deposits at the insertion have been observed to resolve with TrP inactivation.

'''Distinguishing TrPs from bursitis at this location:''' Only supraspinatus TrPs also cause spot tenderness in the '''midportion''' of the supraspinatus muscle above the spine of the scapula. Subdeltoid and subacromial bursitis cause tenderness beneath the deltoid and acromion respectively, but do '''not''' cause midmuscle spot tenderness. Finding both a subacromial tender spot AND a midmuscle tender spot confirms TrP involvement.

=== Screening Tests ===

==== Mouth Wrap-around Test ====

See [[Muscle:Levator_Scapulae#Mouth_Wrap-around_Test_(Shoulder_Girdle_Screen)|Mouth Wrap-around Test]] for full procedure. Restriction from supraspinatus TrPs is due to pain throughout the abduction arc. The position-dependent modification (less restriction supine than upright) is diagnostically informative.

==== Hand-to-shoulder Blade Test ====

This test (see [[Muscle:Infraspinatus#Hand-to-shoulder_Blade_Test|Hand-to-shoulder Blade Test]]) is '''less specifically affected''' by supraspinatus TrPs than by infraspinatus TrPs. Infraspinatus TrPs severely restrict this test; supraspinatus TrPs produce less restriction of the behind-the-back movement.

== Differential Diagnosis ==

=== Infraspinatus ===
The most important muscle to distinguish from supraspinatus in the shoulder. Key differentiators:
* Supraspinatus: '''mid-deltoid''' pain; pain extending to the '''lateral epicondyle'''; pain throughout abduction arc; gradual onset from loading
* Infraspinatus: '''deep inside the front of the joint''' (patient covers front of shoulder with hand); pain extending down the anterolateral arm to the lateral forearm and radial hand (no epicondyle); acute onset with recalled incident; cannot sleep on either side
* Both muscles frequently develop TrPs together — the infraspinatus-supraspinatus team — and dual involvement is the rule rather than the exception

=== Subdeltoid and Subacromial Bursitis ===
Both bursitis and supraspinatus TrPs cause tenderness at the tendinous attachment beneath the acromion. Distinguishing features:
* '''Only TrPs''' cause spot tenderness in the midportion of the supraspinatus muscle (above the spine of the scapula)
* Subdeltoid bursa tenderness is more diffuse than the spot tenderness of deltoid TrPs
* Subacromial bursitis is diagnosed by tenderness directly under the acromial process with the arm at rest, reproducing the patient's pain — but this finding is indistinguishable from supraspinatus enthesopathy by palpation alone
* The diagnostic test that favours bursitis over TrPs is reproducing pain by application of resistance at 90° of arm abduction — but supraspinatus TrPs can also reproduce this finding
* Both conditions may coexist: enthesopathy from TrP taut-band tension at the supraspinatus attachment is in direct contact with the subacromial bursa, and may cause secondary inflammatory changes in it. When both are present, both must be treated.

=== Rotator Cuff Tear ===
* Rotator cuff tear is diagnosable with high accuracy by MRI; ultrasound is reliable for large tears, less so for small ones
* '''Pain in a specific small arc of motion''' (rather than throughout the arc) suggests structural rotator cuff pathology — evaluate urgently
* '''If rotator cuff damage is suspected, the supraspinatus must not be stretched''' — non-stretching TrP treatments only until structural integrity is confirmed
* Conservative treatment of tears <1 cm² with duration <1 year shows continuing improvement through 18 months; TrP inactivation (non-stretching methods) should be included — TrPs likely contributed to the overload that caused the tear
* The diagnosis "impingement syndrome" or "rotator cuff disease" are neither specific nor satisfactory without further characterisation

=== C5–C6 Radiculopathy ===
Supraspinatus TrPs refer pain in the C5 distribution. Neurogenic sources produce electromyographic evidence of denervation (positive sharp waves and fibrillation potentials) in muscles supplied by the compromised nerve — muscles with only myofascial TrPs show no EMG denervation evidence. Patients with nerve entrapment can also have TrPs that contribute significantly to their pain; the two conditions are not mutually exclusive.

=== Suprascapular Nerve Entrapment ===
Both suprascapular nerve entrapment and supraspinatus TrPs cause shoulder pain. Entrapment at the suprascapular notch involves both the supraspinatus and infraspinatus; entrapment at the spinoglenoid notch involves the infraspinatus only. Prolonged nerve conduction latency and/or muscle atrophy are required to diagnose entrapment. A patient should not be considered for surgical release of the suprascapular ligament without positive electrodiagnostic findings. Note that after surgical release, a significant proportion of patients retain persistent shoulder pain — myofascial TrPs are likely candidates for unresolved pain in these cases.

=== Scapulohumeral Imbalance ===
TrPs can cause increased muscle tension, incoordination, and inhibition in the same functional unit, creating a potent source of glenohumeral instability. The characteristic clinical symptom is '''catching''' — sudden severe pain on a specific elevation movement, relieved by returning the arm to neutral. This recurs predictably and resolves with TrP inactivation. Distinguishing features from structural instability: no history of dislocation, reproducible only by that specific movement, reliably resolved by TrP treatment.

=== Brachial Neuritis, Supraspinatus Tendinitis, Frozen Shoulder ===
All may be confused with supraspinatus TrPs. In every case, an essential step is to identify the TrPs that reproduce the patient's pain. Patients who arrive with these diagnoses and have not responded to treatment should be examined for midmuscle supraspinatus TrP tenderness.

== Treatment ==

=== Important Precaution ===
'''If rotator cuff damage is suspected, the supraspinatus must not be stretched.''' In this situation, treatment is limited to: TrP pressure release, deep massage to the taut band, gentle hold-relax techniques without range of movement, indirect techniques (e.g. Hoover or Jones strain-counterstrain principles), and/or injection. Vapocoolant or icing may precede any of these.

=== Trigger Point Release ===

'''Spray and stretch:'''
# Patient seated, forearm placed behind the back at waist level (the stretch position of the Hand-to-shoulder Blade Test)
# After preliminary spray sweeps, the arm is moved further across the back to take up slack
# Patient encouraged to relax by leaning back and pinning the arm against the chair back
# Vapocoolant is applied in slow parallel sweeps from medial to lateral, in line with the supraspinatus fibres, across the acromion and over the deltoid, down the arm to the elbow and over the forearm
# Separate sweeps upward over the upper trapezius (commonly co-involved)
# Hot packs applied, followed by full active range of motion
# Alternate stretch: arm brought across the front of the chest — this does not provide as much medial rotation as the behind-the-back position

'''Postisometric relaxation (Lewit technique):'''
The arm is held at the elbow and moved across the patient's chest to take up slack. The patient inhales and gently presses the elbow laterally against the clinician's light resistance. On slow exhalation and relaxation, the clinician moves the arm further across the chest to take up additional slack. Can be taught as a home self-stretch.

'''Addressing both supraspinatus and infraspinatus together:'''
When both muscles are extremely sensitive and the patient cannot place the hand behind the back, use the arm-across-the-front position for spray and stretch — vapocoolant is applied over the same pattern as for the behind-the-back position.

=== Trigger Point Injection ===

'''Patient position:''' Lying on the uninvolved side.

'''Three injection sites:'''

'''1. Midfibre (central) TrP''' — located by palpation and injected with a 3.2–3.8 cm (1.25–1.5 in) needle directed downward into the bony fossa of the scapula below and behind the edge of the upper trapezius. If the needle is inserted too far lateral and angled medially (rather than directed vertically), it may encounter the upper trapezius TrP₂, producing a visible LTR and referred pain to the neck; advancing deeper then reaches the supraspinatus TrP and elicits its referred pattern to the upper limb.

'''2. Lateral trigger area (musculotendinous junction)''' — in a large patient may require a 5 cm (2 in) needle directed deep into the supraspinous fossa. The needle must be directed precisely to the spot of deep tenderness. '''If directed too far caudally from behind the clavicle, the needle can inadvertently pass anterior to the scapula into the rib cage — avoid.''' Needle contact with the sensitive musculotendinous region typically flashes referred pain to the deltoid and down the arm. Procaine is usually effective; where tenderness at this musculotendinous junction is due to a sterile tissue reaction from prolonged overload, injection with analgesic and a corticosteroid (with appropriate limits on frequency and dose) may hasten recovery. '''Corticosteroid is NOT recommended for the central midfibre TrPs.'''

'''3. Subacromial/humeral attachment''' — tenderness persisting beneath the acromion after inactivation of supraspinatus TrPs is likely due to enthesopathy of the humeral attachment, commonly identified as supraspinatus tendinitis. This responds to injection of local anaesthetic followed by passive stretch and spray, then a hot pack.

After any injection: stretch and spray, hot packs, full range of active motion.

=== Self-Treatment ===

'''Self-stretch under warm shower:'''
Seated on a stool, patient slowly pulls the forearm across and upward behind the back with the other hand to the stretch position (as in Figure 21.4). Warm water directed on the supraspinatus muscle during stretching. Alternatively, the elbow of the involved side is brought across the front of the chest with the other hand.

'''Trigger point pressure release (Theracane®):'''
Most effective with the involved arm relaxed and supported in a comfortably adducted position. While pressure is maintained, take up slack by sliding the hand behind the back as muscle tension reduces.

== Patient Education ==

=== Activity Modification ===

'''Avoid sustained downward traction on the arm:'''
* Do not carry a heavy briefcase, shopping bag, or camera bag with the arm hanging at the side on the affected side — use a backpack, a trolley, or transfer to the unaffected side
* Do not walk a strong dog on the affected side

'''Avoid sustained or prolonged arm elevation:'''
* Do not maintain the arms in abduction or flexion for extended periods (e.g. holding arms up continuously to put curlers in the hair, or performing sustained overhead work)
* Drop the arms briefly at regular intervals during overhead tasks to allow the muscle to replenish its blood supply — the supraspinatus reaches a state of fatigue within a fraction of a minute at 90° of elevation

'''Avoid overhead lifting:'''
* Do not lift heavy objects to or above shoulder height until TrPs have been inactivated

== Satellite Trigger Points ==

* [[Muscle:Infraspinatus]] — most commonly co-active; the supraspinatus-infraspinatus team develops TrPs together with great regularity; treat both
* [[Muscle:Trapezius/Upper]] — commonly involved as part of the functional unit; may be active simultaneously
* [[Muscle:Deltoid]] (middle) — lies in the pain reference zone of the supraspinatus; may develop satellite TrPs
* [[Muscle:Latissimus_Dorsi]] — if active as an antagonist, its TrPs reduce arm abduction; inactivating latissimus TrPs increases abduction range

== Related Pages ==

* [[Pain:Upper_Back_and_Shoulder]] — Diagnostic algorithm for upper back and shoulder pain
* [[Muscle:Infraspinatus]] — Most important co-active muscle; differential for deep anterior shoulder pain and behind-the-back restriction; see comparative table
* [[Muscle:Subscapularis]] — Differential for posterior shoulder pain and frozen shoulder; antagonist
* [[Muscle:Deltoid]] — Satellite TrP zone; differential for mid-deltoid pain
* [[Muscle:Trapezius/Upper]] — Commonly co-active; functional unit partner
* [[Muscle:Teres_Minor]] — Rotator cuff partner; synergist for humeral head stabilisation
* [[Muscle:Latissimus_Dorsi]] — Antagonist; its TrPs restrict abduction

== References ==

* Travell JG, Simons DG. ''Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1: The Upper Half of Body''. 2nd ed. Baltimore: Williams & Wilkins; 1999. Chapter 21.
* Travell JG, Simons DG. ''Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1''. 2nd ed. Chapter 18 (Overview of the Upper Back, Shoulder, and Arm Region).

[[Category:Muscle]]
[[Category:Vol1_Ch21]]
[[Category:Upper_Back_and_Shoulder]]
[[Category:Rotator_Cuff]]

Muscle:Supraspinatus - Revision history