Abstract
The teres major muscle is susceptible to the development of myofascial pain syndrome. Stretch or impact injuries to the teres major muscle sustained while playing sports or in motor vehicle accidents, as well as falls onto the lateral scapula, have been implicated in the evolution of teres major syndrome. In addition, repeated microtrauma secondary to reaching up and behind, such as when retrieving a briefcase from the backseat of a car, overhead throwing, and other sports injuries may result in the development of myofascial pain in the teres major muscle. Treatment of teres major syndrome is focused on blocking the myofascial trigger and achieving prolonged relaxation of the affected muscle. Conservative therapy consisting of trigger point injections with local anesthetic or saline solution is the starting point. Because underlying depression and anxiety are present in many patients suffering from fibromyalgia of the cervical spine, the administration of antidepressants is an integral part of most treatment plans. Pregabalin and gabapentin have also been shown to provide some palliation of the symptoms associated with fibromyalgia.
Keywords
fibromyalgia, myofascial pain, shoulder pain, upper extremity pain, cervical radiculopathy, trigger points, trigger point injection, antidepressants, pregablin
ICD-10 CODE M79.7
The Clinical Syndrome
The teres major muscle is susceptible to the development of myofascial pain syndrome. Stretch or impact injuries to the teres major muscle sustained while playing sports or in motor vehicle accidents, as well as falls onto the lateral scapula, have been implicated in the evolution of teres major syndrome. In addition, repeated microtrauma secondary to reaching up and behind, such as when retrieving a briefcase from the backseat of a car, overhead throwing, and other sports injuries may result in the development of myofascial pain in the teres major muscle ( Figs. 35.1 and 35.2 ).
Myofascial pain syndrome is a chronic pain syndrome that affects a focal or regional portion of the body. The sine qua non of myofascial pain syndrome is the finding of myofascial trigger points on physical examination. Although these trigger points are generally localized to the part of the body affected, the pain is often referred to other areas. This referred pain may be misdiagnosed or attributed to other organ systems, thus leading to extensive evaluation and ineffective treatment. Patients with myofascial pain syndrome involving the teres major muscle often have referred pain in the shoulder that radiates down into the upper extremity.
The trigger point is pathognomonic of myofascial pain syndrome and is characterized by a local point of exquisite tenderness. Mechanical stimulation of the trigger point by palpation or stretching produces not only intense local pain but also referred pain. In addition, involuntary withdrawal of the stimulated muscle, called a jump sign, is often seen and is characteristic of myofascial pain syndrome. Patients with teres major syndrome exhibit trigger points lateral to the scapula in the teres major muscle ( Fig. 35.3 ).
