In all likelihood, shoulder and wrist pain will continue to get worse, perhaps leading to a more severe injury of the subscapularis. The locomotor system informs us of dysfunction by way of pain and tension. Our job is to ascertain the pattern of dysfunction and provide appropriate treatment. This process is easier when we understand that human beings are affected by stereotypical patterns of muscle imbalances that often occur in predictable kinetic chain reactions. Even elite athletes who are quite mobile can develop the same imbalances.
Research suggests that muscle imbalances begin during adolescence.
You should already begin to wonder how this pattern might influence normal shoulder movements and special motions, such as the golf swing, that result in significant activation of the subscapularis. These questions are not typically addressed during the treatment of golfers or when exercises are recommended. It is not uncommon for golfers with shoulder pain to exercises that strengthen the subscapularis and stretch out posterior shoulder muscles, including the infraspinatus, teres minor and rhomboids. If a patient's pain derives from subscapularis dysfunction, these exercises are the exact opposite of what should be done. As suggested by the pain referral pattern illustrated in Figure I , any patient with shoulder pain should be examined for trigger points in the subscapularis.