Trigger Point Therapy for Myofascial Pain by L.M.T. L.Ac. Donna Finando

tuberosities of the humerus, just distal to the lateral aspect of the acromion. (These are best palpated with the arm externally rotated.) The bicipital groove lies medial to the greater tuberosity and lateral to the lesser tuberosity. Note that the tendon of the long head of the biceps brachii runs through the bicipital groove.
    Locate pectoralis major with the patient lying supine, his arm resting at his side. Palpate pectoralis major throughout its course, beginning at its medial attachment at the sternum and the medial two-thirds of the distal aspect of the clavicle. Move laterally across the chest wall to its lateral attachment at the bicipital groove. The lateral aspect of the muscle, its free edge, may be lifted slightly off the chest wall in order to directly palpate the fibers using a pincer grasp palpation technique.
    Pain pattern: Pain in the anterior aspect of the shoulder, at the anterior deltoid region; the pain pattern may include the anterior chest and breast. Pain may extend down the ulnar aspect of the arm to the fourth and fifth digits. Pain may sometimes mimic angina pectoris.
    Causative or perpetuating factors: Overload stresses due to heavy lifting with arms in front of the body; immobilization of the arm in an adducted position; sustained round-shouldered position; sustained anxiety levels; referred phenomena via a viscerosomatic route associated with cardiac infarction.
    Pectoralis major pain pattern
    Strengthening exercise: Lie in the supine position, arms abducted to 90 degrees and palms facing the ceiling. Horizontally flex the arms across the chest, keeping the elbows straight. Slowly return the arms to the starting position. Repeat five to ten times, flexing to a count of two and returning to the starting position to a count of four.
    Satellite trigger points: Anterior deltoid, sternocleidomastoid, scalenes, trapezius, rhomboids.
    Affected organ systems: Respiratory and cardiovascular systems.
    Associated zones, meridians, and points: Ventral zone; Foot Yang Ming Stomach meridian, Hand Tai Yin Lung meridian, Foot Tai Yin Spleen meridian, Foot Shao Yin Kidney meridian; ST 14, 15, and 16; ST 18; LU 1, 2, and 3; SP 19 and 20; KI 22–27.
    Stretch exercise: With the forearms placed firmly on each side of a doorway, stretch the body through the outstretched arms, opening the chest and anterior shoulder region.
    1.   Place the palms approximately at ear level to stretch the upper fibers of pectoralis major.
    2.   Place the elbows level with the shoulders to stretch the middle fibers of pectoralis major.
    3.   Extend the arms fully, placing the hands well above the level of the head to stretch the lower fibers of pectoralis major.
    Stretch exercise 1: Pectoralis major
    Stretch exercise 2: Pectoralis major
    Stretch exercise 3: Pectoralis major
    Deltoid (anterior) and trigger points
    Deltoid (posterior) and trigger points

D ELTOID
    Proximal attachment: Anterior fibers: lateral one-third of the clavicle. Medial fibers: acromion. Posterior fibers: spine of the scapula.
    Distal attachment: Deltoid tuberosity of the humerus.
    Action: Anterior fibers: flexion and internal rotation of the humerus. Medial fibers: abduction of the humerus. Posterior fibers: extension and external rotation of the humerus.
    Palpation: To locate the deltoid, identify the following structures:
Clavicle—Follow the curved course of the clavicle, from its articulation with the sternum to its articulation with the acromion. Medially the contours of the clavicle are convex; laterally its contours are concave. The anterior deltoid attaches to the clavicle at its lateral concavity where the pectoralis major muscle ends.
Acromion—The flat, lateral aspect of the scapula at the most lateral tip of the shoulder girdle. Abducting the humerus as you palpate the lateral tip of the shoulder girdle, you can clearly distinguish between the acromion and the head of the humerus.
Spine of the scapula—Follow