The teres major is a muscle located in the shoulder. It lies between the scapula (scapula) and the arm bone (humerus). It helps to take the arm back (extension), bring it closer to the trunk (adduction) and turn it in. However, it is not among the quadrilateral muscle group that rotates the shoulder called the rotator cuff. The rotator cuff muscles, consisting of the supraspianatus, infraspinatus, teres minor and subscapularis muscles, attach to the shoulder joint capsule, while teres major attaches further down to the intertubercular groove of the humeral bone.

What is Teres Major Syndrome?

The teres major muscle is prone to develop myofascial pain syndrome . It can be injured as a result of stretching or direct impact type injuries in situations such as sports, falls, traffic accidents. Performing movements that require continuous reaching up and back for work may also cause repetitive microtrauma and lead to the development of myofascial pain in the teres major muscle.

Myofascial pain syndrome is a chronic condition that causes regional pain in one part of the body. The defining feature of myofascial pain syndrome is the detection of trigger points during examination of the affected area. Pain occurs when trigger points are pressed. These tense and sensitive fibers in the muscles are also called kulunç among the people . Although it causes pain in a local area, it can also reflect on other parts of the body. For this reason, it can be difficult to diagnose and can be confused with other diseases. Failure to recognize myofascial pain syndrome may result in unnecessary investigations and treatments. In Teres major syndrome, the pain may radiate from the shoulder to the arm.

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In myofascial pain syndrome, pain occurs when the affected muscle is pressed or stretched. At this time, involuntary twitching of the muscle and a characteristic reaction called “jump sign” can be seen in the person. Teres major syndrome develops due to the trigger point of the teres major muscle on the outer side of the scapula. When the muscle is examined by touch, tense fibers are felt in it. It is not known exactly how and why trigger points occur. Sudden trauma, repetitive strain, or imbalances between shoulder girdle muscle strength can cause initiation.

Factors such as starting sports without conditioning, poor posture, past injuries, chronic stress, depression, and malnutrition are risk factors for the development of myofascial pain syndrome.

There may be muscle stiffness and weakness along with the pain. As a result, functional limitation may develop and affect daily life. Myofascial pain syndrome can be found alone or in combination with other diseases such as neck hernia, rotator cuff tear.

Signs and Symptoms

The main finding of teres major syndrome is a trigger point in the teres major muscle on the outer side of the shoulder blade (scapula) behind the shoulder. With mechanical stimulation in the form of pressing or stretching, pain may occur both in that area and in the shoulder and arm. The jumping sign is also characteristic.

Diagnosis

There is no objective diagnostic test. Findings specific to myofascial pain syndrome cannot be detected with tools such as blood tests, imaging methods, and EMG. Diagnosis is made by medical history and physical examination findings. Other diseases and problems that may cause similar symptoms should be excluded.

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Differential diagnosis

Problems such as shoulder bursitis , tendinitis , rotator cuff tear, neck hernia may lead to similar findings. Imaging methods such as MRI and ultrasonography can be used to differentiate these conditions. Other diseases such as rheumatic diseases, muscle inflammation, fibromyalgia , multiple sclerosis should be considered according to the additional signs and symptoms. Psychological diseases can coexist with myofascial pain syndrome, increase or mask complaints.

Treatment

In the treatment, the trigger point in the muscle is blocked and the muscle is relaxed. For this, local anesthetic injection or dry needling can be done. Physical therapy methods such as TENS, hot or cold applications, and exercise are also effective. If there are accompanying problems such as fibromyalgia, depression and anxiety, appropriate treatments are given.

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