The tenoperiosteal site of the supraspinatus is the most common localisation where deep transverse friction massage is performed
The patient sits with his arm behind the back (medial rotation makes the insertion of the tendon, now lying in front of the acromion, accessible to the finger). We can palpate the spine of the scapula in a lateral direction ; as soon as we lose contact with the bone, we come back onto the bone and palpate now in an anterior direction. We know for sure that we are on the acromion. The tendon, with its insertion on the greater tuberosity, is found just beyond the anterior edge of the acromion.
The deep transverse friction massage is done in the normal way, with the index finger of the ipsilateral hand, reinforced by the middle finger. The thumb should be placed quite far down the arm. So that a downward pressure is exerted on the greater tuberosity, the index finger-nail remaining horizontal. (Were the thumb to be put posteriorly, with the nail of the index finger pointing anteriorly, a pressure would be exerted to the front of the acromion and the lesion would be missed. This is frequently made error.) It is possible that there is minor tenderness on palpation, but more tenderness lateral and medial to the structure. Don't be confused by this fact ; it is possible that poor vascularization of the tenoperiosteal area causes this discrepancy in symptoms.
