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June, 2014, Vol. 14, Issue 06

The Forgotten Rotator Cuff Muscle, Part 3

By Ben Benjamin, PhD

When treating the teres minor, the injury usually occurs either in the tenoperiosteal junction or in the tendon body itself. Let's take a moment to review the tenoperiosteal junction. This is where the tendon attaches to the bone. The teres minor attachment is just lateral to the infraspinatus tendon.

And if you have ever done cadaver work, you know that it's enmeshed in a common fascia. Sometimes the teres minor is sometimes even conjoined with the infraspinatus tendon.

So, what this means is you're going to work on the most lateral part of the tendon attachment to the greater tubercle of the humerus. Or you will move slightly distal to the lateral aspect of the tendon body itself. When this tendon attachment or tendon is injured, it's extremely tender to the touch.

I remember one client who said to me, "Wouldn't that hurt anybody?" To which I replied, "no as a matter of fact it wouldn't." So, I asked him to turn over on his other side and did the same palpation to his healthy teres minor tendon. He was amazed that it didn't hurt at all. This is often a good way to educate your clients that both the pain on the assessment tests and on the palpation together form the evidence as to what is injured.

Rotator Cuff - Copyright – Stock Photo / Register Mark For the treatment, first ask the client to lie on their side, injured side up, with a pillow under their head to protect their neck. Then you have the arm extended upward at about 70°. This puts the teres minor on the stretch and makes it easier to access and treat the tendon or its attachment.

Using your thumb, find the greater tubercle which is going to be a prominent bump at the posterior aspect of the shoulder. Now, move to the most lateral portion of the tubercle and palpate the tendon both as it attaches to the bone and further distally at the tendon body. When you palpate it, if it's injured it will be quite uncomfortable to the touch.

The treatment involves a friction therapy at a 90° angle to the injured tendon done in one direction only for a period of five minutes with a break and then another for five minutes. Remember to keep the discomfort to a minimum just so that it is slightly annoying but never really painful. You have to be able to do this treatment for a period of time in order for it to succeed, so be sure to monitor the discomfort of your client has you work.

The client may be sore for up to 48 hours. Don't forget to tell them that so they understand it if they are sore for a few days. They may not be sore at all and that's okay, too.

In part four of this series, we will go over the exercise programs that assist in the rehabilitation and healing process.

Click here for more information about Ben Benjamin, PhD.


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