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Trigger-& Accupressure Points Muscular Pain, Tension, & Dysfunction
Trigger-& Accupressure Points Muscular Pain, Tension, & Dysfunction
VOLUME I
UPPER EXTREMITIES
BY
TORBJORN M. HANSON, A.c., MANUAL THERAPIST
T. HANSON 2012
Muscular Imbalance
Sprains, strains or micro tearing due to overuse or trauma of certain muscles leads to an
accumulation of tension, i.e. muscle shortening and adhesions.
Anytime there is muscle shortening, and subsequent muscle lengthening of the
antagonistic muscles, there is a MUSCULAR IMBALANCE. In other words, the
body is out of ALIGNMENT.
The core theory in H.M.T. is that muscular imbalance is the cause of injuries and decreased
performance.
Muscle shortening causes:
Decreased range of motion
Postural imbalances
Change joint positions with decreased joint space
Decreased vascular circulation
Inhibition of lymphatic drainage
Decreased strength
Friction, pressure, compression and excessive pulling over time leads to dysfunction,
inflammation and pain. This pain is caused by soft tissue damage or nerve entrapment and
ultimately leads to neuropathy, joint pathology and joint degeneration.
Circuit Breakers
Accumulation of tension in muscles, fascia and tendons manifest as hypersensitive myofascial
reflex points know as trigger points or acupressure points. Those reflex points act as circuit
breakers and when overloaded with excessive tension can give rise to local or referred pain.
Trigger or acupressure points are activated directly by acute overload, overwork, fatigue or direct
trauma to the muscle they are located in. Those reflex points can also be activated indirectly by
other reflex points, visceral disease, joint dysfunction, or emotional distress. Once a reflex point
is activated, repeated muscular stress of a lesser degree can activate pain in the reference zone,
especially when the muscle becomes fatigued.
Research shows that a change in electrical resistance (3) and temperature (4) can be measured at
the dermal location of a reflex point. This can be confirmed with ohm meters and thermograms.
Proper release of tension in a reflex point will immediately abolish readings of changed electrical
resistance. Inactivation of the reflex point allows associated muscle(s) to return to proper tone
and hence restore muscular balance.
Releasing tension to acupressure or trigger points in shortened muscles is very effective in
reducing joint pressure and restoring range of motion. Lasting results will be achieved in
eliminating local or referred pain caused by muscle shortening. This also improves vascularity
and lymphatic drainage which stimulates the bodys natural self-curative abilities.
Due to somatovisceral effects, a release of a hypersensitive myofascial reflex point can improve
tension related visceral ailments and provide emotional release.
Some theories suggest that digital pressure applied to acupressure points may also stimulate the
nervous system to release neuro-hormones (such as endorphins). Research has documented that
this is the case with acupressure (5). This would explain the analgesic effect often experienced
with the release of an acupressure point. The analgesic effect is generally short lasting in cases of
joint or nerve pathology. In other cases however, endorphin release may break the pain cycle and
promote lasting or permanent relief.
References:
(1) Travell J. Bigelow NH: Referred somatic pain does not follow a simple segmental
pattern. Fed Proc 5:106, 1046.
(2) Travell J. & Simons D: Myofascial pain and dysfunction. The trigger point manual,
upper extremities. Vol. 1, pg. 15, 1983.
(3) Sola AE and Williams RL: Myofascial pain syndromes. Neurol 6:91-95, 1956.
(4) Fisher AA: Thermography and pain. Arch Phys Med Rehabil 62:542, 1981.
(5) Mayer FJ, Price DD, Barber J, et al: Acupuncture analgesia: Evidence for activation
of pain inhibitory system as a mechanism of action. In advances in pain research and
therapy, edited by J.J. Bonica, D. Albe-fessard, Vol 1 Raven press, New York 1976
(pp. 751-754).
Objective #1
Objective #2
- Impact
- Sudden uncontrolled body movement
= Immediate tissue damage and tension.
Microtrauma
- Nutritional deficiencies
- Dehydration
- Toxic conditions
= Lymphatic congestion and muscular tension
Environmental cause:
- Allergies
= Lymphatic congestion with muscular tension.
HMT
Synopsis
Use form A:1-3 for Anterior, Posterior and Lateral view Posture Evaluation.
Reference; Postu-Rx Manual for Muscle Imbalance or DVD to establish
standard for normal posture. Each postural imbalance indicates which muscles are
tense / shortened or elongated.
Use form B:1 for the upper extremities, form B:2 for lower extremities and spine to
establish standard for normal range of motion.
Reference; Postu-Rx Manual for Muscular Imbalance or DVD to establish
standards for normal range of motion. Each range of motion imbalance indicates
which muscles are tens / shortened or elongated.
Use form C:1, for testing upper extremity muscles #1-35 or form C:2 for lower
extremity and spine muscles #36-72. Each muscle will test either normal,
hypotonic/weak/elongated, or hypertonic/tense/shortened.
Reference; HMT Manual Muscle Testing manual I (upper extremity, muscles # 135), and II (lower extremity and spine, muscles #36-72).
Muscle Testing and Function by Kendall or Applied Kinesiology, Synopsis by
Walther, can also be used.
Ask the Patient where the pain is felt and fill in the
appropriate pain zones
Use form D:1, For the patient to indicate pain patterns on anterior, posterior or
lateral illustration.
Example I:
Postural Exam:
Anterior view show a medially rotated right arm. See exam form A-1 on page #11
This indicares that the muscles that medially rotate the arms are relatively shorter (more
contracted) than the muscies that laterally rotate the arms. This also indicates that the
muscles that laterally rotate the arms are relatively elongated compared to the muscles
that medially rotate the arms.
Shortened muscles
Medial rotators of arm
#8 Pectoralis Major Clavicular
#9 Pectoralis Major Sternal
#10 Latissimus Dorsi
#12 Teres Major
#14 Subscapularis
#18 Deltoid Anterior
Elongated muscles
Lateral rotators of arm
#16 Infraspinatus
#17 Teres Minor
#20 Deltoid Posterior
Posterior view shows and elevated right scapula. See exam form A-2 on page #12
This indicates that the muscles that elevate the scapula are shortened and the muscles that
depress the scapula are elongated
Shortened muscles
Elongated muscles
#1 Trapezius Upper
#3 Trapezius Lower
#5 Levator Scapulae
(#10 Latissimus Dorsi)
#6 Rhomboids
#7 Pectoralis Minor
Lateral view shows a right anterior humeral head. See exam form A-3 on page #13
This indicates that the muscles that pull the humeral head anterior are shortened, and the muscles
that pull the humeral head posterior are elongated.
Shortened Muscles
Elongated Muscles
Pull humeral head anterior
Humeral head posterior
#1 Trapezius Upper
#2 Trapezius Middle
#4 Serratus Anterior
#3 Trapezius Lower
#7 Pectoralis Minor
#20 Deltoid Posterior
#8 Pectoralis Major Clavicular
#9 Pectoralis Major Sternal
#18 Deltoid Anterior
#27 Coracobrachialis
Mark form E:1 with the muscles that are shortened and elongated in the Postural Evaluation.
See example page 23.
10
JOE DEMO
D1
Have patient use a colored pen. Stripe zones with moderate pain.
Checker zones with severe pain.
PAIN MAPPING
A1
JOE DEMO
123-45-6789
AGE: _________
RIGHT
DATE
DATE
EXAM BY
A
A
A
A
A
A
A
A
A
A
A
EXAM BY
1. FEET
NO. 1:1
NO. 1:2
Normal = A
Supinated = B
Pronated = C
NO. 1:3
2. LEG LENGTH
NO. 1:4
3. KNEES
NO. 1:6
4. FEMUR
NO. 1:3
Normal = A
Right Shorter = C
Left Shorter = B
NO. 1:5
Normal = A
Bowlegged = B
Knock-kneed = C
NO. 1:7
Normal = A
Medial Rotation = C
Lateral Rotation = B
5. HIPS
NO. 1:8
NO. 1:8
Normal = A
Right Higher = C
Left Higher = B
6. SHOULDERS
NO. 1:9
NO. 1:9
Normal = A
Left Higher = B
Right Higher = C
NO. 1:10
NO. 1:10
NO. 1:11
NO. 1:10
Normal = A
Right Anterior rot. = B Left Anterior rot. = C
NO. 1:10
Normal = A
Right Anterior rot. = B
Left Anterior rot. = C
NO. 1:11
Normal = A
Right Tilt = B
NO. 1:12
Left Tilt = C
NO. 1:12
Normal = A
Turned Right = B
Turned Left = C
9. ARMS
NO. 1:14
Normal = A
Lateral Rotation = B
Medial Rotation = C
NO. 1:13
A
A
A
A
A
A
A
A
A
A
C
NOTES: ____________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Copyright 1996-2011 Sports Performance Rehabiolitation & Fitness Systems, Tobjorn Hanson, Bertil Sultan
11
A2
HansOn Muscle Therapy
POSTURAL EVALUATION
JOE DEMO
123-45-6789
LEFT
RIGHT
DATE
DATE
EXAM BY
A
A
A
A
A
A
A
A
A
A
A
A
A
A
NO. 2:1
EXAM BY
1. ACHILLES TENDON
NO. 2:2
Normal = A
Supinated = B
Pronated = C
2. KNEES
NO. 1:5
Normal = A
Knock-kneed = C
Bow Legged = B
NO. 1:4
3. HIPS
NO. 1:8
Normal = A
Left Higher = B
Right Higher = C
NO. 1:8
4. RIB CAGE
NO. 2:3
NO. 2:3
Normal = A
Right Side Lower = C
Left Side Lower = B
NO. 2:4 5A. ENTIRE SPINE CURVATURE NO. 2:4
Normal = A
Curve Apex Left = C
Curve Apex Right = B
NO. 2:5
Normal = A
Curve Apex Right = B
Curve Apex Left = C
NO. 2:6
NO. 1:9
6. SHOULDERS
NO. 2:6
Normal = A
Curve Apex Right = B
Curve Apex Left = C
A
A
A
A
A
A
A
NO. 1:9
Normal = A
Left Higher = B
Right Higher = C
Adducted = C
NO. 1:11
Right Tilt = B
NO. 1:12
NO. 1:11
Normal = A
Left Tilt = C
NO. 1:12
Normal = A
Turned Right = B
Turned Left = C
A
B
A
A
A
NOTES: ____________________________________________________________________________________
Copyright 1996-2011 Sports Performance Rehabiolitation & Fitness Systems, Tobjorn Hanson, Bertil Sultan
12
A3
JOE DEMO
123-45-6789
AGE: _________
Lateral View
LEFT
RIGHT
DATE
DATE
EXAM BY
A
A
1. KNEES
NO. 3:2
Normal = A
Flexed = C
Hyperextended = B
2.
PELVIS
&
LUMBER
SPINE
NO. 3:3
NO. 3:3
NO. 3:1
Normal = A
Posterior tilt / lack of lumber curve = B
Anterior tilt / excess lordosis = C
NO. 3:4
EXAM BY
4. ABDOMEN
A
A
A
A
5. HEAD TILT
NO. 3:6
Normal = A
Posterior tilt / excess lordosis = B
Anterior tilt / straight neck = C
NO. 3:7
Posterior = B
NO. 3:9
Excessive = B
6. HUMERAL HEAD
Normal = A
7A. ELBOW FLEXION
Normal = A
NO. 3:5
Normal / flat = A
Protruding = B
NO. 3:6
NO. 3:4
Normal = A
Excess kyphosis / head forward = B
Lack of thoracic curve / head posterior = C
NO. 3:5
NO. 3:8
Anterior = C
NO. 3:10
Deficient = C
C
A
NOTES: ____________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Copyright 1996-2011 Sports Performance Rehabiolitation & Fitness Systems, Tobjorn Hanson, Bertil Sultan
13
Elongated muscles
Shoulder abductors
#11 Supraspinatus
#18 Deltoid Anterior
#19 Deltoid Middle
#20 Deltoid Posterior
Upper Extremity ROM shows limited and painful lateral rotation (with 90 degrees
of abduction) on the right. See exam form B-1 on page #16
This inidcates that the medial rotators of the arm are shortened and the lateral rotators are
elongated which would limit lateral rotation.
Shortened muscles
Elongated muscles
Medial rotators
Lateral rotators
#8 Pectoralis Major Clavicular
#16 Infraspinatus
#9 Pectoralis Major Sternal
#17 Teres Minor
#10 Latissimus Dorsi
#20 Deltoid Posterior
#12 Teres Major
#14 Subscapularis
#18 Deltoid Anterior
14
Cervical ROM shows that lateral flexion to the left is limited. See exam form B-3 on page #17
This indicates that the muscles responsible for lateral flexion to the left are elongated.
Muscles responsible for the antagonistic (opposite) movement, lateral flexion to the right
are shortened.
Shortened muscles
Elongated muscles
Right lateral Flexors
Left lateral flexors
#1 Trapezius Upper
#1 Trapezius Upper
#36 Sternocleidomastoid
#36 Sternocleidomastoid
#37 Scalenes
#37 Scalenes
#39 Neck Extensors
#39 Neck Extensors
Mark form E:1 with the muscles that are tested shortened and elongated in the Range Of
Motion Assessment. See example page 23.
15
B1
JOE DEMO
123-45-6789
Upper Extremity
DATE
A
A
EXAM BY
A
A
A
A
A
A
Hyper Extension
60
4:13
4:2
Flexion
180
4:14
Range
240
4:3
Abduction
180
4:15
4:4
Adduction
75
4:16
Range
255
4:5
Lat. Rotation
90
Shoulder 4:6
Med. Rotation
70
Range
Horiz. Abduction
Horiz. Adduction
Range
160
Left
A
A
A
A
No.
4:1
A
A
A
A
DATE
AVG. RANGE
MOTION
4:7
4:8
Left
4:20
- or +
4:23
4:24
4:26
4:29
4:33
4:34
Left
4:35
4:36
4:27
Right
Flexion
Range
150
Supination
Pronation
Range
Extension
Flexion
80 - 90
4:31
80 - 90
4:32 Forearm
4:28
150
160 -180
70
4:37
80
4:38
30
4:39
Radial Deviation
Range
20
4:40
50
Elbow
Right
Right
Range
Ulnar Deviation
150
C
A
A
A
180
4:22
Forearm 4:30
Wrist
130
- or +
4:11
Elbow
4:19
4:21
4:10
Left
Right
4:18 Shoulder
50
A
A
C
A
4:17
- or +
4:9
AGE: _________
Wrist
A
A
A
A
A
A
A
A
The zero position is the plane of reference. When a part fails to reach the zero position, the degrees designated the joint motion obtained, are subtracted in
computing the range of motion. For reporting range of motion POSTU-Rx software program use Normal=A, Higher=B and Lower=C.
NOTES: _______________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Copyright 1996-2011 Sports Performance Rehabilitation & Fitness Systems, Tobjorn Hanson, Bertil Sultan
16
B3
JOE DEMO
123-45-6789
DIAGNOSIS : _________________________________________________________________________
AGE: _________
SPINE
No.
AVG.
RANGE
6:1
45
6:2
45
MOTION
Flexion
Extension
Range
Lateral bending left
Lateral bending right
Range
Rotation/Turning left
Rotation/Turning right
Range
Flexion
Extension
Range
Lateral bending left
Lateral bending right
EXAM BY
A
A
90
6:3
45
6:4
45
Cervical
Spine
90
6:5
6:6
70
6:7
80
6:8
20-30
A
A
100-110
6:9
35
6:10
35
70
6:11
45
6:12
45
C
A
A
A
70
140
Range
Anterior rotation left
Anterior rotation right
Range
DATE
Thoracic &
Lumber
Spine
90
A
A
A
A
The zero position is the plane of reference. When a part fails to reach the zero position, the degrees designated the joint motion obtained, are subtracted in
computing the range of motion. For reporting range of motion POSTU-Rx software program use Normal=A, Higher=B and Lower=C.
NOTES: _______________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Copyright 1996-2011 Sports Performance Rehabilitation & Fitness Systems, Tobjorn Hanson, Bertil Sultan
17
Mark form E:1 with the muscles that tested shortened/Hyper Tonic or Elongated /
Hypotonic on Manual Muscle Testing. See example page 23.
18
C1
HansOn Muscle Therapy
UPPER EXTREMITY MUSCLE CHART
JOE DEMO
123-45-6789
LEFT
RIGHT
EXAMINER DATE
#1
C2, 3, 4 - Trapezius, upper - S.I, U.B., G.B.
#2
C2, 3, 4 - Trapezius, middle - S.I., U.B., T.W.
#3
C2, 3, 4- Trapezius, lower - U.B.
#4
C5, 6, 7, 8 - Serratus anterior - Lu, Sp, P., G.B.
#5
C3, 4, 5 - Levator scapulae - S.I.
#6
C4, 5 - Rhomboids - U.B.
#7
C6, 7, 8, T1 - Pectoralis minor - Lu, St., Sp., P.
#8 C6,7,8,T2 - Pectoralis major (Clavicular division) - Lu.,St.,Sp.,K.
#9
C6,7,8,T2 - Pectoralis major (Sternal division) - St.,Sp.,K.,P.
#10
C6, 7, 8 - Latissimus dorsi - U.B., G.B.
#11
C4, 5, 6 - Supraspinatus - L.I., S.I., T.W.
#12
C5, 6, 7 - Teres major - S.I.
#13
Shoulder medial rotators
#14
C5, 6, 7 - Subscapularis - H.
#15
Shoulder lateral rotators
#16
C4, 5, 6 - Infraspinatus - S.I.
#17
C5, 6 - Teres minor - T.W.
#18
C5, 6 - Deltoid anterior - L.I.
#19
C5, 6 - Deltoid middle - L.I., T.W.
#20
C5, 6 - Deltoid posterior - S.I., T.W.
#21
C5, 6 - Biceps long head - Lu., P.
#22
C5, 6 - Biceps short head - Lu., P.
#23
C5, 6 - Brachialis - Lu., H., P.
#24
C7, 8 - Triceps long head - S.I., T.W.
#25
C7, 8 - Triceps medial head - L.I., S.I., T.W.
#26
C7, 8 - Triceps lateral head - T.W.
#27
C6, 7 - Coraco brachialis
#28
C5, 6 - Brachioradialis - Lu., L.I.
#29
C5, 6, 7 - Supinators - Lu., L.I.
#30
C6, 7 - Pronator teres - P.
#31
C7, 8, T1 - Pronator quadratus - Lu., H., P.
#32
C6, 7, 8 - Flexor carpi radialis - P.
#33
C7, 8, T1 - Flexor carpi ulnaris - H.
#34
C5, 6, 7, 8 - Extensor carpi radialis - T.W.
#35
C6, 7, 8 - Extensor carpi ulnaris - S.I., T.W.
#1
#2
#3
#4
#5
#6
#7
#8
#9
#10
#11
#12
#13
#14
#15
#16
#17
#18
#19
#20
#21
#22
#23
#24
#25
#26
#27
#28
#29
#30
#31
#32
#33
#34
#35
ABBREVIATION KEY: = Hypotonic when manually tested, GRADING SCALE; 0 = Gone, no contraction felt, 1= Trace; muscle can be felt to tighten, but
cannot produce movement, 2 = Poor; produces movement with gravity eliminated, but cannot function against gravity, 3 = Fair; can raise part against gravity.
4 = Good; can raise part against outside resistance as well as against gravity, 5 = Normal; can overcome a greater amount of resistance than a good muscle,
= Hypertonic when manually tested, F = Flexibility/Stretching Exercise, S = Strengthening Exercise, TP = Trigger Points, TP = Trigger Points with referred
pain, s.c.s. = Strain Counter Strain, i.m. = Ice Massage.
Copyright 2011 Sports Performance Rehabilitation & Fitness Systems, Tobjorn Hanson, Bertil Sultan
19
20
21
II
III
IV
7 PAIN ZONES
VI
VII
#9
#12
#14
#8
#10
#1
#7
IIII
IIII
IIII
IIII
IIII
lll
lll
22
UPPER EXTREMITY
#9
PECTORALIS MAJOR
STERNAL
Origin: Anterior surface of the sternum, cartilage of the first six or seven ribs,
aponeurosis of the External Oblique.
Insertion: Crest of the greater tubercle of the humerus. The fibers twist on themselves
and are more posterior and cranial in comparison to the clavicular fibers.
Action:
Adducts and medially rotates humerus. Horizontally adducts humerus towards the
contralateral anterior superior iliac spine.
Reversed origin-insertion and change of action:
The Pectoralis Major Sternal may assist in elevating the thorax as in forced inspiration. In
crutch walking or in parallel bar work, it will assist in supporting the weight of the body.
Myotatic unit / Synergists & Antagonists:
Adduction of humerus:
Synergists: #8 Pectoralis Major Clavicular, #10 Latissimus Dorsi, #12 Teres Major, #24
Triceps Long Head, #27 Coracobrachialis.
Antagonists: #11 Superspinatus, #18 Anterior Deltoid, #19 Middle Deltoid, #20 Posterior
Deltoid.
Medial rotation of humerus:
Synergists: #8 Pectoralis Major Clavicular, #10 Latissimus Dorsi, #12 Teres Major, #14
Subscapularis, #18 Anterior Deltoid.
Antagonists: #16 Infraspinatus, #17 Teres Minor, #20 Posterior Deltoid.
Horizontal adduction of the humerus:
Synergists: #8 Pectoralis Major Clavicular.
Antagonists: #2 Middle Trapezius, #3 Lower Trapezius.
Nerve Suppy: Lateral and medial pectoral, C6, C7, C8, T1
9:1
I
I
I
II
II
TP III
22
TP IV
9:2
III
II
9:3
Entrapments:
Entrapment of a lymph duct by passage between tense, shortened fibers of an involved
Pectoralis Major Sternal may cause edema of the breast. These signs of entrapped
lymphatic drainage and breast tenderness are relieved by extinction of the related TPs.
Pectoralis Major Sternal Trigger Points:
TPs are localized through the Pectoralis Minor against the chest wall. Trigger points in
the Pectoralis Minor may be distinguished from Pectoralis Major by the fiber direction of
palpable bands (TPs).
TP I :
Location: Three trigger points are found in the lateral portion of the muscles sternal
division. Between the 2nd and 4th ribs approximately 4.5-5.5 cun lateral to the center of
the sternum.
Referred Pain Pattern: Anterior chest, down the inner aspect of the arm, accented pain
in the area of the medial epicondyle. In severe cases the pain will travel to the volar
aspect of the forearm and the ulnar side of the hand, the last 2 of 2 digits usually
innervated by the sensory fibers of the ulnar nerve.
TP II:
Location: Two trigger points are found in the medial sternal section, 0.5-1.5 cun lateral
to the center of the sternum, between the 3rd and 4th rib.
Referred Pain Pattern: Locally in the medial portion of the muscle, and over the
sternum without crossing the midline.
TP III:
Location: Two trigger points are found in the costal/abdominal section of the muscle at
the lateral free margin of the muscle approximately 5-6 cun lateral to the center of the
sternum in the region of the 4th intercostals space.
Referred Pain Pattern: Pain in the lower anterior chest, breast tenderness with
hypersensitivity of the nipple, intolerance to clothing and often breast pain.
TP IV:
Location: One trigger point is located medially in the costal/abdominal section of the
muscle. The same location or nearby the K. 22 acupuncture point, in the 5th intercostals
space, 2 cun lateral to the center of the sternum.
Referred Pain Pattern: Local spot tenderness associated with ectopic cardiac rhythms,
but not with any pain complaint.
When active trigger points occur in the left pectoralis major, the referred pain can easily
be confused with coronary insufficiency. All patients with those symptoms should be
checked by their physician to clear any cardiac disease or dysfunction.
It is possible for coronary artery insufficiency or other intrathoracic organ
diseases/dysfunctions to create viscerosomatic satellite trigger points in the skeletal
muscles of the anterior chest wall. Caution must be taken so that release of trigger points
in this area are not masking any organ pathology, always refer to the patients physician
when in doubt.
9:4
On the other hand it is possible for active trigger points to mimic pai patterns of cardiac
or gallbladder pathology without any organ dysfunction to be found. Release of those
trigger points will permanently relieve symptoms.
Associated Trigger Points:
#2 Middle Trapezius, #4 Serratus Anterior, #6 Rhomboids, #7 Pectoralis Minor, #8
Pectoralis Major Clavicular, #10 Latissimus Dorsi, #14 Subscapularis, #17 Teres Minor,
#18 Anterior deltoid, #20 Posterior deltoid, #27 Coracobrachialis, #36
Sternocleidomastoid, #37 Scalenes.
Satellite Trigger Points:
#7 Pectoralis Minor, #8 Pectoralis Clavicular, #10 Latissimus Dorsi, #14 Subscapularis,
#30 Pronator Teres, #32 Flexor Carpi Radialis, #33 Flexor Carpi Ulnaris. These muscles
lie within the zones of referred pain from TPs in the Pectoralis Major Sternal.
Pain experienced in the Pectoralis major clavicular can be of a referred nature from
trigger points in the following muscles:
#4 Serratus Anterior, #7 Pectoralis Minor #37 Scalenes.
Acupuncture Meridians:
Stomach (St.), Spleen (Sp.), Kidney (K.), Pericardium (P.)
Pectoralis Major sternal Local Acupuncture points:
St. 15:
Location: In the 2nd intercostal space on the mammillary line.
Indications: Cough, asthma, fullness in the chest, mastitis.
St. 16:
Location: In the 3rd intercostals space on the mammillary line.
Indications: Cough, asthma, fullness of the chest, mastitis.
St. 17:
Location: In the center of the nipple, in the 4th intercostals space.
Indications: Therapy is contraindicated.
St. 18:
Location: In the 5th intercostals space on the mammillary line.
Indications: Cough, Asthma, mastitis, lactation deficiency, pain in the chest.
Sp. 18/TP:
Location: 2 cun lateral to the nipple, in the 4th intercostals space.
Indications: Sensation of fullness and pain in the chest, cough, mastitis, lactation
deficiency.
9:5
Sp. 19:
Location: In the 3rd intercostal space, 6 cun lateral to the center of the sternum.
Indications: Sensation of fullness and pain in the chest and hypochondriac region.
K. 22/TP
Location: In the 5th intercostals space, 2 cun lateral to the center of the sternum.
Indications: Cough, Asthma, local point tenderness associated with ectopic cardiac
rhythms.
K. 23
Location: In the 5th intercostals space, 2 cun lateral to the center of the sternum.
Indications: Cough, Asthma, sensation of fullness in the chest and hypochondriac region,
mastitis.
K. 24
Location: In the 4th intercostals space, 2 cun lateral to the center of the sternum.
Indications: Cough, Asthma, sensation of fullness in the chest and hypochondriac region,
mastitis.
K. 25
Location: In the 3rd intercostals space, 2 cun lateral to the center of the sternum.
Indications: Cough, Asthma, chest pain.
K. 26
Location: In the 1st intercostals space, 2 cun lateral to the center of the sternum.
Indications: Cough, Asthma, sensation of fullness in the chest and hypochondriac region.
P. 1/TP
Location: 1 cun lateral to the nipple in the 4th intercostals space.
Indications: Suffocating sensation in the chest, pain in the hypochondriac region,
swelling and pain of the axillary region.
9:6
UPPER EXTREMITY
#12 -
TERES MAJOR
Origin: Dorsal surface of the inferior angle and lower third of the lateral border of the
scapula.
Insertion: Crest of the lesser tubercle of humerus.
Action:
Medially rotates, adducts, and extends the shoulder joint.
Reversed Origin-Insertion and Change of Action: When arm is fixed, Superior
rotation of the glenoid cavity.
Myotatic unit / Synergists & Antagonists:
Medial rotation of the Humerus:
Synergists: #8 Pectoralis major clavicular, #9 Pectoralis major sternal, #10 Latissimus
dorsi, #14 Subscapularis, #18 Anterior deltoid.
Antagonists: #16 Infraspinatus, #17 Teres minor, #20 Posterior deltoid.
Adduction of the Humerus:
Synergists: #8 Pectoralis major clavicular, #9 Pectoralis major sternal, #10 Latissimus
dorsi, #24 Triceps long head, #27 Coracobrachialis.
Antagonists: #11 Superspinatus, #18 Anterior deltoid, #19 Middle deltoid, #20 Posterior
deltoid.
Extension of the Humerus:
Synergists: #10 Latissimus dorsi, #20 Posterior deltoid, #24 Triceps long head.
Antagonists: #8 Pectoralis major clavicular, #18 Anterior deltoid, #21 Biceps long head,
#22 Biceps short head, #27 Coracobrachialis.
Glenoid Cavity rotated superiorly:
Synergists: #1 Upper Trapezius, #3 Lower trapezius, #4 Serratus anterior.
Antagonists: #5 Levator scapula, #6 Rhomboids, #10 Latissimus dorsi.
Nerve Supply: Lower subscapular, C5, C6, C7.
Teres Major Trigger Points:
TP I :
Location: In the posterior axillary fold, 1.5 cun into the axilla, where the Latissimus
dorsi wraps around the Teres major.
12:1
PT . I
II
12:2
II
12:3
TP II:
Location: Close to the origin of the muscle on the inferior angle of the scapula.
Referred Pain Pattern: Posteriorly into the shoulder joint, occasionally to the dorsal
forearm.
Associated Trigger Points:
#10 Latissimus dorsi, #14 Subscapularis, #16 Infraspinatus, #17 Teres minor, #18
Anterior deltoid, #24 Triceps long head.
Satellite Trigger Points:
#11 Supraspinatus, #16 Infraspinatus, #17 Teres minor, #18 Anterior deltoid, #34
Extensor carpi radialis, #35 Extensor carpi ulnaris.
Pain experienced in the Teres Major can be of a referred nature from trigger points
in the following muscles:
#4 Serratus anterior, #5 Levator scapula, #10 Latissimus dorsi, #11 Supraspinatus, #14
Subscapularis, #16 Infraspinatus, #17 Teres minor, #20 Posterior deltoid, #24 Triceps
long head, #37 Scalenes.
Acupuncture Meridians:
Small Intestine (S.I.)
Teres Major Local Acupuncture points:
S.I. 9:
Location: Posterior and inferior to the shoulder joint. When the arm is adducted, the
point is 1 cun above the posterior end of the axillary fold.
Indications: Pain in the scapular region, pain and motor impairment of the hand and arm.
12:4
UPPER EXTREMITY
#14 -
SUBSCAPULARIS
14:1
TP. I
III
II
14:2
#14 Subscapularis
III
II
14:3
14:4