Infraspinatus Pain Causes, Symptoms, and Treatments (2023)

The infraspinatus is one of four muscles that make up the rotator cuff, which helps your arm and shoulder move and stay stable.

Your infraspinatus is in the back of your shoulder. It attaches the top of your humerus (the top bone in your arm) to your shoulder, and it helps you rotate your arm to the side.

Pain in the infraspinatus is most likely caused by repetitive motion involving the shoulder. Swimmers, tennis players, painters, and carpenters get it more frequently. It also becomes more likely as you get older.

There are several potential causes of infraspinatus pain. Some are serious, but none are life threatening.

Sometimes, infraspinatus pain is due to minor strains or wear and tear. In these cases, rest will likely relieve the pain. But your pain may also be caused by an injury or more serious conditions.

Infraspinatus tear

There are two types of infraspinatus tears:

  • A partial tear will damage the tendon, but it doesn’t go all the way through. It’s usually caused by repetitive stress or normal aging.
  • A complete, or full-thickness, tear severs the infraspinatus from the bone. It’s usually caused by an acute injury, such as falling.

Symptoms

  • pain at rest
  • pain at night
  • arm weakness
  • pain when lifting or lowering your arm
  • crackling sensation when moving your arm
  • if you have an acute tear, it’ll cause severe, sudden pain and weakness

Infraspinatus tendinopathy

Infraspinatus tendinopathy is a less severe injury to the infraspinatus. There are two types:

  • Tendonitis is an inflammation of the tendon.
  • Tendinosis is small tears in the tendon that don’t cause much inflammation.

Causes of tendinopathy include:

  • overuse, especially reaching overhead or throwing
  • shoulder trauma
  • arthritis or another inflammatory disease in your shoulder
  • normal wear and tear as you age

Symptoms

  • pain that increases with shoulder use
  • dull ache in your shoulder and upper arm
  • pain at night
  • shoulder weakness
  • shoulder stiffness
  • some loss of motion in your shoulder
  • pain while reaching overhead
  • pain while reaching behind you

Infraspinatus impingement

Impingement is when a tendon gets compressed, usually by a bone spur or inflammation. Infraspinatus impingement is uncommon in people who aren’t in sports that involve overhead throwing, such as tennis. It’s particularly common in athletes under age 30.

Symptoms

  • pain across the whole shoulder
  • pain down arm
  • pain that gets worse over time

Bursitis

Bursitis occurs when the bursa — a fluid-filled sac between the top of your arm bone and the tip of your shoulder — becomes inflamed. This can cause pain and restrict the infraspinatus muscle’s movements.

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Overuse is the most common cause of bursitis, but it can also be caused by:

  • arthritis
  • gout
  • diabetes
  • thyroid disease
  • tendonitis
  • acute injury

Symptoms

  • shoulder swelling
  • pain when moving your shoulder

Pinched nerve

If the suprascapular nerve in your shoulder gets pinched, it can cause infraspinatus pain. A pinched nerve is usually due to trauma, overuse injuries, or as a result of other shoulder dysfunction.

Symptoms

  • pain at the back and top of your shoulder
  • pain that doesn’t respond to most normal treatments
  • shoulder weakness
  • atrophy of the infraspinatus (in rare cases)

Trigger points — which not all doctors believe actually exist — are thought to be hard, tender spots in a muscle.

Latent trigger points hurt when they’re pushed on, while active trigger points cause pain even without touch or motion. They can cause not only pain, but restrict motion and cause muscle weakness.

Active trigger points can cause pain at the spot in the muscle or referred pain. Referred pain is pain in other areas of the body, usually ones near the trigger point.

Trigger points are usually activated by stress on the muscle. If you have active trigger points in your infraspinatus, it can cause pain in your shoulder and down your arm.

Treatment may include:

  • dry needling
  • anesthetic injections
  • stretching
  • massage
  • laser therapy
  • nonsteroidal anti-inflammatory drugs (NSAIDs)

Diagnosing infraspinatus pain

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To diagnose the cause of your infraspinatus pain, a doctor will first take a look at your medical history. They’ll ask you about:

  • your symptoms
  • when the symptoms started
  • any recent injuries
  • if you play sports or have other activities with repetitive shoulder motion

Then, they’ll do a physical exam to see what motions hurt your shoulder, if your range of motion is limited, and if your shoulder muscles seem weak.

Usually, a medical history and physical exam are enough to diagnose an infraspinatus problem. But a doctor may also do an X-ray to rule out other possibilities or an ultrasound or MRI to confirm a diagnosis.

If a doctor isn’t sure whether you have an infraspinatus tear or tendinopathy, they may inject the muscle with a local anesthetic. If you have tendinopathy, the pain will improve and your muscle strength will be normal. If you have a tear, your arm function will still be limited.

Infraspinatus pain test

An infraspinatus pain test is used to see whether your pain is coming from the infraspinatus or another part of your shoulder.

You’ll bend your arms 90 degrees, with your palms facing up. Your elbows should be at your sides, and your arms should be out in front of you.

A doctor will push against your arms while you rotate them outward. If this hurts, you most likely have an infraspinatus problem.

In most cases, a doctor will recommend trying nonsurgical treatment for infraspinatus pain. These treatments are successful for most people, although a combination of nonsurgical treatments may be necessary.

If nonsurgical treatment isn’t effective, surgery may be an option.

Rest

Infraspinatus injuries are often caused by repetitive motion. Resting your shoulder will give it a chance to heal. A doctor might recommend resting your arm in a sling or temporarily avoiding activities that cause more pain.

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Heat and ice

Icing your shoulder will reduce inflammation. You can do this early on in your injury or after you exercise or stretch.

Heat will help relax your infraspinatus. You should apply heat before stretching or exercising. Using a heating pad or taking a warm bath or shower are effective.

Infraspinatus pain stretches and exercises

Stretches and exercises will help you improve flexibility and range of motion. They’ll also help you strengthen your muscles to avoid further injury. None of these stretches or exercises should cause pain. If they do, stop and tell your doctor.

A doctor may also recommend physical therapy. They can give you additional exercises to do at home.

Here are some exercises you can try:

Pendulum

This exercise helps stretch your muscles and the space they pass through so that you don’t get a frozen shoulder.

  1. Lean forward at an angle. Use your nonaffected arm for support.
  2. Slowly swing your affected arm forward and backward, then side to side.
  3. Then move it in small circles.
  4. Do 2 sets of 10 of each.

External rotation

This exercise helps strengthen and stretch your infraspinatus. As you heal, you can start adding weights.

  1. Lie on your side and rest your head on your arm
  2. Bend the arm you’re not lying on 90 degrees so your elbow is in the air, your hand is on the ground, and your arm is running across your stomach.
  3. Keep your elbow at your side and slowly rotate your arm. It should end up bent 90 degrees with your hand in the air.
  4. Slowly rotate the arm back down.
  5. Do 2 sets of 10.
  6. Repeat on the other side.

Passive external rotation

You should feel this stretch in the back of your shoulders. You’ll need a light stick, like a yardstick or broom handle.

  1. Loosely grab the stick on each end.
  2. Keep the elbow of your affected arm against your body.
  3. Use the other arm to gently push the stick horizontally so that the affected elbow is against your side and the affected arm is bent 90 degrees, perpendicular to your body.
  4. Hold for 30 seconds.
  5. Relax for 30 seconds.
  6. Repeat 3 more times.
  7. Repeat on the other side.

NSAIDs

NSAIDs like ibuprofen (Advil, Motrin) relieve pain and reduce swelling caused by your injury.

Steroid injections

Steroid injections use a mix of local anesthetic and cortisone, which is an anti-inflammatory steroid. Your doctor will inject this mix directly into your infraspinatus or bursa, depending on your specific condition.

These injections can provide temporary relief, but can damage your muscle if done too often.

Surgery

Surgery can be done for severe injuries or if other treatments have failed. It’s typically only done as a first treatment if you have a severe, acute injury, such as a complete tear from a fall.

There are different types of surgery. Your doctor should discuss your options with you.

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Your doctor will most likely recommend rest, exercises, and stretching first. If those don’t start to help within a few weeks, you should go back to your doctor for further evaluation.

At this point, they may recommend continuing exercises or give you a steroid injection. Injections usually start working to decrease pain within a few days.

If you still have pain after 6 months, your doctor might see if you’re a good candidate for surgery. Open surgery, which uses one large incision, has a longer healing time than arthroscopic surgery, which uses several small incisions.

It usually takes approximately 6 months before your shoulder function will return to normal after surgery. Depending on how well you’re healing, you can likely return to some activities within 4 months.

Infraspinatus pain can be a sign of a serious condition. But in most cases, it can be resolved with treatments such as rest, stretching, and NSAIDs.

If you have shoulder pain and weakness, especially if you do a lot of repetitive arm motions in your daily life, talk to your doctor. They can help you find the cause of your pain and treatment options.

FAQs

What causes pain in the infraspinatus muscle? ›

Pain in the infraspinatus is most likely caused by repetitive motion involving the shoulder. Swimmers, tennis players, painters, and carpenters get it more frequently. It also becomes more likely as you get older.

Where do you feel infraspinatus pain? ›

The most common chief complaint area of MTrPs in the infraspinatus muscle was the scapular area. The most common pattern of referred pain was the anterolateral aspect of the arm (above the elbow).

How do I release my infraspinatus? ›

And as soon as you find it go a little bit lower and then rotate your upper arm outwards. And by

How long does a infraspinatus strain take to heal? ›

Your doctor or physical therapist can recommend other exercises that can help you maintain the strength and flexibility of your joints. Recovery from a small tear or tendinitis can take between 2 and 4 weeks, or sometimes a few months.

How do you treat an infraspinatus tear? ›

Possible treatments for an infraspinatus tear may include:
  1. RICE (rest, ice, compress, elevate)
  2. Surgery based on the severity of the tear to reattach the muscle tendon.
  3. Steroid injections.
  4. Non-Steroidal Anti-Inflammatory medications.
  5. Addressing the scar tissue formation in the shoulder joint.
  6. Stretching.
8 Aug 2022

How do you test for infraspinatus? ›

The patient is asked to externally rotate both forearms against the examiner's resistance. The test is positive when there is weakness or pain in external rotation. Infraspinatus tears are usually painless so external rotation weakness strongly suggests infraspinatus tear.

Can an infraspinatus tear heal on its own? ›

In most rotator cuff tears, the muscle partially or fully tears away from the bone. Rotator cuff tears won't heal on their own. You'll need rotator cuff repair to restore your shoulder joint.

How do you massage an infraspinatus? ›

Self-Massage for the Infraspinatus - YouTube

Can you tear your infraspinatus? ›

The most common injuries to the infraspinatus muscle are tendinitis (or tendinopathy) and a tear of the tendon. Tendinitis is an inflammation of the tendon which usually is a result of repetitive overhead reaching, pushing, or lifting with outstretched arms.

What movements does the infraspinatus do? ›

Infraspinatus is one of the four rotator cuff muscles, alongside subscapularis, teres minor and supraspinatus muscles. As a part of the rotator cuff muscles, the main function of infraspinatus muscle is external rotation of the humerus, as well as stabilization of the glenohumeral, or shoulder joint.

What is infraspinatus Tendinosis? ›

Rotator cuff tendinosis (the disease and degeneration process) occurs when the small muscles of the rotator cuff, the supraspinatus, infraspinatus, teres minor, and subscapularis, become strained, causing weakness of these structures and subsequent tendonitis (tendon inflammation).

What does an infraspinatus tear feel like? ›

Infraspinatus tendon tears frequently occur in overhead athletes, as a result of overuse injury, or in chronic shoulder instability. The main complaints are pain while sleeping, weakness in the affected arm, and inability to move the arm in certain motions.

Is infraspinatus a rotator cuff muscle? ›

The infraspinatus is a portion of the rotator cuff muscles composed of the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles act to stabilize the glenohumeral joint.

What are 2 warning signs of a rotator cuff tear? ›

The pain associated with a rotator cuff injury may:
  • Be described as a dull ache deep in the shoulder.
  • Disturb sleep.
  • Make it difficult to comb your hair or reach behind your back.
  • Be accompanied by arm weakness.
18 May 2022

What is the O Brien's test? ›

The O'Brien test is a simple procedure that healthcare professionals use to assess shoulder pain. It can detect a cartilage (labral) tear or an acromioclavicular (AC) joint problem. It's also called the active compression test.

What does an infraspinatus tear feel like? ›

Infraspinatus tendon tears frequently occur in overhead athletes, as a result of overuse injury, or in chronic shoulder instability. The main complaints are pain while sleeping, weakness in the affected arm, and inability to move the arm in certain motions.

Can a infraspinatus tendon tear heal itself? ›

Even though most tears cannot heal on their own, you can often achieve good function without surgery. If, however, you are active or use your arm for overhead work or sports, surgery is most often recommended because many tears will not heal without surgery.

How do you stretch the infraspinatus? ›

Infraspinatus Stretching - YouTube

How do you massage the infraspinatus muscle? ›

Treating Trigger Point Release - Infraspinatus Muscle - YouTube

What are 2 warning signs of a rotator cuff tear? ›

The pain associated with a rotator cuff injury may:
  • Be described as a dull ache deep in the shoulder.
  • Disturb sleep.
  • Make it difficult to comb your hair or reach behind your back.
  • Be accompanied by arm weakness.
18 May 2022

What causes infraspinatus Tendinosis? ›

Rotator cuff tendonitis occurs with muscle weakness or injury. Rotator cuff tendonitis occurs when the small muscles of the rotator cuff, the supraspinatus, infraspinatus, teres minor, and subscapularis, become strained causing weakness of these structures and subsequent tendonitis.

Is infraspinatus tendon part of rotator cuff? ›

The infraspinatus is a portion of the rotator cuff muscles composed of the supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles act to stabilize the glenohumeral joint. The tendons of these muscles are nonlinear, viscoelastic, and heterogeneous.

How should I sleep with shoulder pain? ›

A better side-sleeping position is lying on the opposite shoulder with the painful shoulder toward the ceiling. Then place the pillow in the armpit of the injured shoulder to hold it up slightly and take pressure off the rotator cuff.

Will a cortisone shot help a torn rotator cuff? ›

Cortisone is a powerful anti-inflammatory that can be injected into the shoulder area to help treat a variety of shoulder conditions, including tendinitis, bursitis, rotator cuff impingement or tear, frozen shoulder, and degenerative or inflammatory arthritis.

What movement does the infraspinatus muscle do? ›

Action. Infraspinatus is the main external rotator of the shoulder joint. It assists in producing shoulder extension. With the arm fixed, it abducts the inferior angle of the scapula.

How do I relax my shoulder muscles? ›

Shoulder stretch
  1. Relax your shoulders.
  2. Raise one arm to shoulder height, and reach it across your chest.
  3. Pull the arm slightly toward you with your other arm. This will help you get a gentle stretch. Hold for about 6 seconds.
  4. Repeat 2 to 4 times.

How do you relieve rotator cuff pain at night? ›

Heat or Ice Therapy for Rotator Cuff Pain Relief

Try applying a heating pad to your shoulder for 15 minutes at a time as you begin your bedtime routine. Alternate 15 minutes of heat and 20 minutes off while winding down in the evening. Make sure you don't fall asleep with the heating pad on.

Videos

1. 5. Rotator Cuff Rehabilitation Shoulder impingement pain relief - Infraspinatus exercises
(Mr. Physio 호주물리치료사)
2. Top 3 Signs Of A Rotator Cuff Tear (Updated)
(Bob & Brad)
3. Infraspinatus Pain and Trigger Points
(TrPTherapist)
4. Top 5 Signs of a Rotator Cuff Tear
(Tim Fraticelli - PTProgress)
5. Anatomy Of The Infraspinatus Muscle - Everything You Need To Know - Dr. Nabil Ebraheim
(nabil ebraheim)
6. Infraspinatus Tear Evaluation: Special tests and Manual Muscle Testing
(Ortho EVAL Pal With Paul Marquis PT)
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