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Massage Today
April, 2014, Vol. 14, Issue 04

The Forgotten Rotator Cuff, Part 2

By Ben Benjamin, PhD

Let's continue looking at the teres minor muscle – tendon unit; how to assess it and treat it.

The arm is overhead, the elbow bent at about 15 degrees, hand facing anteriorly above the forehead. The practitioner then gently grasps the clients wrist on the ulna side. The client pushes up as you apply an equal and opposite force down. Remember with resisted tests no movement through space should occur. It often takes very little pressure to induce the pain when a teres minor injury is present so start out with very little pressure.

In this next test, we combine lateral rotation with adduction (with the hand at the Elbow). Since the teres minor is both lateral rotator and an adductor of the shoulder, this test performs both at the same time. The client bends the elbow at 90 degrees and brings it a few inches away from the body. The practitioner places one hand on the distal dorsal forearm just proximal to the wrist and the other hand on the medial elbow. Now, ask the client to push laterally at their wrist as the try to bring their elbow toward their ribs into adduction.

rotator cuff - Copyright – Stock Photo / Register Mark When the teres minor is injured one or both of these two tests are painful. The overhead push test is most likely to be painful. Differentiating a teres minor from an infraspinatus injury is a very tricky piece of assessment. The first thing to notice is weakness as well as pain. When the body is injured, it's very difficult if not impossible to maintain strength, especially for a little muscle like the teres minor.

To get this injury, people are usually very athletically active. In most cases, the infraspinatus is the one that gets injured when lateral rotation is involved. In order to engage the teres minor you need to do something either very strenuous or something that pulls you to the medial aspect of your hand (that's toward your little finger).

One way to get this injury is by doing a handstand where you have to balance yourself using all parts of the shoulder in subtle ways. In order to balance yourself side to side you have to use the teres minor and if you lose your balance slightly you'll grip with this part of the rotator cuff complex.

So, if your client has pain in one or both of the tests described here, it is highly likely that there is a strain of the teres minor. In part three, we will look at palpation and treatment.


Click here for more information about Ben Benjamin, PhD.

 

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