Subscapularis Tendinosis versus Bicipital and Coracobrachialis Tendinosis

These conditions are typically called tendinitis.  A better term for both of these conditions might be tendon pain or tendinosis, which is the tearing of tendon fibers, due to repeated stress or overload, in the absence of an inflammatory process.  It is important to perform muscle resistance testing to determine which of these muscles are causing anterior shoulder pain.

The long head of the biceps tendon and the subscapularis tendon lie next to each other and general palpation may not be able to determine which muscle is creating the tendon pain.  Even though the pain may be in the same area, the treatment protocol and subsequent stretching are drastically different.

Subscapularis Treatment:subscap2-web

  • Follow the shoulder protocol starting with the velvet glove technique.
  • You will need to release all the other anterior shoulder muscles—pectoralis major, minor, and subclavius—before you work this muscle.
  • Next, follow the specific protocol for the subscapularis including multi-directional friction and eccentric contraction.
  • This is an extremely rare injury, as this muscle has a broad, flat, wide tendon, that is very deep and well protected. Although this muscle is almost always tight, subscapularis tendinosis is rare.

Biceps and Coracobrachialis Treatment:

  • Start with the basic shoulder protocol and release all of the anterior shoulder muscles.
  • The client is supine with the arm supinated, with support under the elbow using a bolster or a towel. Have the client perform a resisted test with the shoulder flexed to 90˚, palm facing up, to pinpoint the injury.
  • Follow the rest of the specific biceps/coracobrachialis protocol.
  • Continue to reassess and repeat any or all of the protocol until the client is pain-free.

biceps_coraco

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