Teres minor tendinopathy

What is Teres Minor Tendinopathy?

The teres minor muscle is part of the rotator cuff and stabilizes the shoulder joint, especially in external rotation. With tendinopathy, the tendon is overloaded, degenerated or irritated in an inflamed manner. This can occur due to repeated strain, incorrect loading, concomitant tightness in the shoulder area or age-related changes.

• Typical location: posterior/posterolateral shoulder, sometimes radiating into the upper arm
• Increased pain during external rotation against resistance, when supporting or during throwing/hitting movements
• Adjacent structures such as the infraspinatus tendon or the posterior joint capsule can also be affected

Anatomy: Role of Teres minor

The Teres minor arises from the lateral edge of the shoulder blade (scapula) and attaches to the lower part of the greater tubercle (head of the humerus). It is innervated by the axillary nerve and works closely with the infraspinatus. Both muscles support external rotation and ensure that the head of the humerus is centered in the joint socket.

• Function: external rotation, stabilization of the shoulder, fine adjustment of the joint mechanics
• Neighborhood: Infraspinatus tendon, posterior capsule, subacromial space
• Load profile: stressed during throwing/hitting and pulling movements, when reaching backwards and when working overhead

Symptoms

• Posterior or posterolateral shoulder pain, often dependent on stress
• Pain and/or weakness with external rotation (e.g., putting on a coat, blow-drying, throwing sports)
• Pressure pain in the back shoulder, sometimes painful lying on the affected side
• Restriction of movement and rapid fatigue during overhead activities
• Night pain possible, especially with inflammatory irritation or greater stress

Causes and risk factors

Often there is a combination of overload and biomechanical factors. Sports with repetitive external rotation and high tensile stress are particularly ideal.

• Repetitive overload: throwing and impact sports, rowing, climbing, strength training (e.g. lat pulldowns, high load rowing)
• Postural and technique factors: scapular dyskinesia, inadequate trunk/scapula control, technique errors
• Degenerative changes in the tendon with increasing age
• Posterosuperior impingement (internal impingement) in overhead athletes
• Muscle imbalances between internal and external rotators, shortened anterior chain
• Rare: Calcifications, narrowing in the quadrilateral or rotator interval area, axillary nerve problems

Diagnostics: step by step

The diagnosis results from anamnesis, clinical examination and – if necessary – imaging procedures. It is important to differentiate from infraspinatus tendinopathy, subacromial impingement, biceps tendon problems and cervical causes of pain.

• Functional tests: external rotation against resistance, Hornblower/Patte sign (pain/weakness in abducted external rotation), external rotation lag sign
• Palpation: tenderness posterolaterally, assessments of scapular function and posture
• Mobility test: internal/external rotation, capsule findings (e.g. posterior capsule tension)
• Ultrasound: dynamic assessment of the tendon, thickening, partial tears, sliding behavior
• MRI: differentiated representation of tendon quality, partial or combined lesions, muscle atrophy; X-ray if calcification or bony tightness is suspected

Differential diagnoses

• Infraspinatus tendinopathy or partial tear
• Supraspinatus tendinopathy with subacromial impingement
• Long biceps tendon (tendinitis/dislocation)
• Cervical radiculopathy, myofascial trigger points
• Posterior labrum lesion, internal impingement during overhead sports
• Quadrilateral space syndrome (compression of the axillary nerve/posterior circumflex artery of the humerus)

Conservative therapy: basis of treatment

Most teres minor tendinopathies respond to consistent conservative treatment. The aim is to reduce pain, apply appropriate stress to the tendon and normalize scapula and rotator cuff function.

• Load adjustment: temporary reduction of provocative movements (repetitive external rotation, explosive overhead work), gradual return to work
• Pain management: short-term NSAIDs (if tolerated), local cooling in the acute phase, later heat and circulation promotion
• Physiotherapy (pain-adapted progression): isometric external rotation exercises, followed by eccentric-concentric training of the external rotators
• Scapular stability: Serratus anterior, trapezius (lower/middle parts), rotator cuff in closed chains
• Mobility: gentle posterior capsular mobilization, thoracic spine mobility; Sleeper stretch only with professional guidance and symptom control
• Everyday ergonomics: workplace adjustment, load management during sports (volume/intensity controlled)
• Optional measures: taping for proprioception, short-term manual therapy for pain relief

Exercises: Build up safely and progressively

Exercises should be individually dosed, painless and carried out regularly. The following are typical building blocks - please have the concrete implementation accompanied by physiotherapy.

Interventional options

If symptoms persist despite structured conservative therapy, targeted interventions can be considered. We discuss benefits and risks transparently and individually.

• Ultrasound-targeted injection: peritendinous corticosteroid infiltration can reduce pain in the short term; strict indication, not intratendinous, attention to possible side effects
• Platelet-Rich Plasma (PRP): Evidence for non-calcifying shoulder tendinopathies heterogeneous; can be considered in selected cases, explanation of unclear effectiveness
• Shock wave therapy (ESWT): solid evidence v. a. at Kalkschulter; variable in non-calcifying tendinopathy – decision on a case-by-case basis
• Guideline-based pain management and, if necessary, a temporary break from sports for overhead athletes

Surgical therapy: rarely necessary

Isolated surgery for teres minor tendinopathy is rare. If conservative measures have been exhausted for months and relevant structural defects exist, arthroscopic treatment can be performed - often in the context of more complex rotator cuff lesions.

• Arthroscopic smoothing (debridement) for irritated, frayed tendon parts
• Refixation for relevant partial/crack forms, especially for combined lesions
• Check accompanying procedures for impingement/tightness individually
• Postoperative rehabilitation with gradual, protocol-based increase in load; Return to sport and work depending on the findings and healing process

Course and prognosis

With consistent conservative therapy, most cases improve within weeks to a few months. For overhead sports, rehabilitation is often longer and requires a structured improvement in performance. Patience, technical training and avoiding overload peaks are crucial.

• Early intervention often shortens the duration of symptoms
• Chronification possible with continued incorrect or overloading
• Accompanying pathologies (e.g. infraspinatus or biceps tendon) can influence the course
• The goal is a resilient shoulder that is suitable for everyday use and sports - without any promise of healing

Prevention and self-help

• Slow training build-up, especially a. with new or more intense external rotation loads
• Balanced strength profile: Targeted strengthening of external rotators and scapular stabilizers
• Technical and posture work (video analysis/coaching in sports)
• Break and regeneration management, sleep and stress periodization
• Workplace ergonomics: screen height, arm rests, break movement
• Early clarification if pain persists to avoid chronicity

When should I seek medical advice?

• Acute shoulder pain after trauma with significant loss of strength
• Severe night pain, pain at rest or rapidly increasing symptoms
• Numbness, tingling, loss of sensation or strength (indication of nerve involvement)
• Fever, redness, warmth or swelling of the shoulder
• Persistent symptoms despite 4-6 weeks of targeted self-help/physiotherapy

Special features of sport and work

In sports - especially throwing, hitting and climbing sports - finely dosed progression and technique training are central. Adjusting lifting and overhead activities helps in everyday work.

• Return-to-Activity: symptom-guided, low-pain and gradual; Use objective markers of strength and control
• Training planning: 10-20% load increase per week as a rough upper limit, plan deload weeks
• Workplace: aids for overhead work, load distribution, micro-breaks

Your orthopedist in Hamburg

In our orthopedic practice at Dorotheenstrasse 48, 22301 Hamburg, we will advise you in detail, conduct a thorough examination and work with you to develop an individual, conservatively oriented treatment plan. If necessary, we coordinate imaging, physiotherapy and - after informed consent - interventional measures.