Likely due to frequent overloading, the trapezius is often the most commonly affected muscle. Prolonged motor endplate malfunction results in a cascade of myoneural changes including muscle fiber degeneration, regional fibrosis, and formation of the characteristic taut bands of MPS.
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8 Theoretically, these states of medical or structural aberrance induce motor endplate dysfunction of the affected neuromuscular junctions. Multiple contributing factors are identified in the development of MPS including trauma, postural imbalances, psychological stressors, sleep deprivation, chronic disease states, vitamin insufficiencies, and spinal degenerative conditions (Table 1).
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In many cases, it is preceded by acute or repetitive muscle trauma. It is occasionally associated with paresthesias. Myofascial pain is aggravated by use of the affected muscle and frequently responds to mechanical stressors such as stretching, pressure, anxiety, cold, or heat. 10 For the purposes of this discussion, MPS will encompass both tender and trigger points.Ĭlinical Presentation And PathophysiologyĬlinically, myofascial pain often presents as a deep aching sensation, described as an area of “tightness” or “stiffness” by the patient. Active trigger points elicit pain spontaneously as well as with compression. Latent trigger points elicit painful sensation only with the application of direct compression. 9 Trigger points are further classified as active versus latent. The major reported difference is that trigger points produce pain in a referred pattern, whereas tender points generate pain at the site of palpation. Local twitch response with needle insertion 7,8Īlthough trigger points are usually differentiated from tender points, there are some suggestions that both are part of one clinical spectrum.Restricted range of motion of involved muscle.Consistent localized or referred pain generation by palpation.Trigger points are most commonly characterized by the following two primary features as well as two secondary features. These trigger points are found within the muscle, fascia, or tendinous insertions and are diagnosed routinely by palpation. 2-5 Although the exact mechanism is not fully understood, myofascial pain syndrome (MPS) is characterized primarily by the development of trigger points. 1 Recent studies have identified a myofascial component of pain in 30% of patients in an internal medicine practice, 55% of those in a head and neck pain clinic, and up to 85% to 95% of cases in a pain center. Although not often considered in the differential diagnosis of musculoskeletal pain until the past 10 to 15 years, myofascial pain is now estimated to affect approximately 44 million Americans. Myofascial pain is an increasingly recognized etiology of non-acute musculoskeletal pain.
#TRAVELL AND SIMONS TRIGGER POINTS RESEARCH TRIAL#
A trial of massage therapy helped temporarily, but the pain seems to return once he resumes his recreational activities. His pain rarely radiates down his arm and typically remains confined to his neck, trapezoid, and periscapular regions (see photo below). While only a 3 out of 10 on the numerical pain scale, his pain seems to persist once it occurs and limits his ability to play tennis, volleyball, or weight lift at the gym.
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He describes his pain as a “tightness,” intermittent, and often occurring at the end of his workday or following exercise. A 31-year-old Web site developer presents to his primary care provider with progressively “annoying” right shoulder and scapular pain that has been present for the past year.