Myofascial pain syndrome (MFPS and myofascial trigger point (MTrP)

key

TrP responsible for activating one or more satellite TrPs. clinically a key TrP is identified when inactivation of that TrP also inactivates the satellite TrP

active

TrP that causes a clinical pain complaint

latent

TrP that is clinically quiescent with respect to spontaneous pain. It is painful only when palpated. May have all the other clinical characteristics of an active TrP and always has a taut band that increases ms tension and restricts ROM

prevelence 269 female student nurses

TrPs found in 54% of lateral pterygoid, in 45% of masseter, in 43% of temporal is, 40% of medial pterygoid, 35% of splenius capitis, 33% of utrap

nociceptive chains of bic. brachii, triceps, supinator, finger ext associated joint fixation

elbo and mid cervical spine

other terms

essential pain zone jump sign local twitch response motor endplate paradoxical (abnormal) respiration referred autonomic phenomena spillover pain zone taut band zone of reference

nociceptive chains of Karel Lewit

founder of the Prague school of manual medicine and rehabilitation utilized and taught manipulation and rehabilitation to treat the locomotor system relationship between fixation/dysfunction of specific motion segments and MTrP of specific muscles

jump sign

general pain response of the patient, who winces, may cry out, and may withdraw in response to pressure applied on a TrP

Myofascial pain syndrome (MFPS or MPS)

general term to describe a regional pain syndrome of any soft tissue origin "the sensory, motor and autonomic symptoms caused by myofascial trigger points

taut band

group of tense muscle fibers extending from a TrP to the muscle attachment. The tension of the fibers is caused by contraction knots that are located in the region of the TrP

hyperirritable spot in skeletal muscle is associated with

hypersensitive palpable nodule in a taut band

vicious cycle of MTrP

increased Ach released fro motor nerve terminal --> sustained Ca2+ released from sarcoplasmic reticulum--> sustained sarcomere contraction --> increased energy demand and decrease energy supply from compression of local capillaries--> energy crisis--> release of sensitizing substances and failure of the Ca2+ pump of the sarcoplasmic reticulum

prevelence 100 asymptomatic subjects

latent TrPs found on 45% of QL, 41% G. Med., 11% G min, 24% ilopsaos, 5% piriformis

energy crisis (2)

leads to release of sensitizing substances that could interact with autonomic and sensory (nociceptive) nerves causes failure of the Ca2+ pump of the sarcoplasmic reticulum

nociceptive chains of pectoralis, rhomboids associated joint fixation

midthoracic spine

latent Trp symptoms

no spontaneous pain

indirect stimuli causes

other TrPs abnormal (paradoxical) breathing joint dysfunction emotional stress nutritional deficiency (esp. H2O soluble vitamins) heart, gallbladder and other visceral disease

signs include

palpable tenderness (tender nodule upon palpation) restricted stretch range of motion (shortened upon muscle length test) taut band fiber with LTR characteristic referred pain, tenderness and/or dysesthesia (hypesthesia, numbness, paresthesia) painful contraction (emphasized when contraction is shortened position) weakness upon muscle strength test

essential pain zone

region of referred pain that is present in nearly every patient when the TrP is active

spillover pain zone

region where some ,but not all, patients experience referred pain beyond the essential pain zone, due to greater hyperirritability of a TrP

paradoxical respiration

simultaneous expansion of the chest and contraction of abdominal muscles that pulls the abdomen inward during inhalation

types of TrP (8)

1) active 2) associated 3) attachment 4) central 5) key 6) latent 7) primary 8) satellite (previously termed, secondary TrP)

physiological causes of MTrP (7)

1) increased Ach released from motor nerve terminal 2) sustained Ca2+ released from sarcoplasmic reticulum 3) sustained sarcomere contraction 4) increased energy demand from sustained contraction and decreased energy supply from compression of local capillaries 5) energy crisis 6) release of neuroactive substances contribute to excessive Ach release 7) self sustaining vicious cycle established

associated

TrP in one ms. that occurs concurrently with a TrP in another ms. One may have induced the other or both ma stem from the same mechnical or neurological origin

nociceptive chains of rectus femoris associated joint fixation

L3-L4

nociceptive chains of piriformis associated joint fixation

L4-L5

nociceptive chains of iliacus associated joint fixation

L5-S1

attachment

TrP at musculotendinous junction and/or at osseous attachment of the muscle that identifies the enthesopathy cause by unrelieved tension characteristic of the taut band that is produced by a central TrP

central

TrP closely associated with dysfunctional endplates and located near of ms belly

satellite

a central TrP that was induced neurogenically or mechanically by the activity of a key TrP. May develop in the zone of reference of the key TrP in an overloaded synergist that is substituting for key ms, in an antagonist countering increased tension of the key ms or in a ms linked apparently only neurogenically to the key Trp

types of TrP

active associated attachment central key latent primary satellite

direct stimuli causes

acute overload overwork fatigue (repetitive stress injury, poor posture) radiculopathy gross trauma

the spot

always painful on compression can give rise to: 1) characteristic referred pain 2) referred tenderness 3) motor dysfunction 4) autonomic phenomena

primary

central TrP that was apparently activated directly by acute or chronic overload or repetitive overuse of the ms in which it occurs and was not activated as a result of TrP activity in another muscle

nociceptive chains of shoulder girdle muscles associated joint fixation

cervicothoracic junction

active TrP symptoms

clinical complaint of myotomal pain (dull, diffuse, achy, referred)

myofascial trigger point

cluster of electrically active loci each of which is associated with a contraction knot and a dysfunctional motor endplate in skeletal muscle

nociceptive chains of SCM, suboccipitals associated joint fixation

craniocervical junction

motor endplate

soleplate ending where a terminal branch of the axon of a motor neuron makes synaptic contact with a striated muscle fiber

symptoms include

sometimes complains of numbness or paraesthesia rather than pain increased muscle tension and shortening spasm of other muscles weakness of involved muscle (from reflex motor inhibition without atrophy of the affected muscle) loss of coordination by involved muscle decreased work load tolerance distorted weight perception of lifted objects sleep disturbances involved limp may feel cold compared to other side (reflex vasoconstriction) abnormal sweating persistent lacrimation persisten coryza excessive salivation pilomotor activities imbalance dizziness tinnitus

zone of reference

specific region of the body at a distance from a TrP, where phenomena (sensory, motor, and/or autonomic) cause by the TrP are observed

nociceptive chains of plantar muscles associated joint fixation

tarsometatarsal joints

nociceptive chains of psoas, QL, T/L erector spinae, Lat. dorsi associated joint fixation

thoracolumbar junction

nociceptive chains of biceps femoris associated joint fixation

tibiofibular joint

local twitch response

transient contraction of a group of tense muscle fibers (taut band) that traverse a TrP. contraction is in response to stimulation (usually by snapping palpation or needling) of the same TrP, or sometimes of a nearby TrP

treatment procedures

trigger point pressure release (replaces the term, ischemic compression) spray and release PIR comb (e-stim+US) followed by stretching or manual therapy other (static stretch, massage, nimmo, heat, TrP injection, dry needling, biofeedback, MRT, etc.)

nociceptive chains of subscapularis associated joint fixation

upper ribs

referred autonomic phenomena

vasoconstriction (blanching), coldness, sweating, pilomotor response, ptosis, and/or hypersecretion that occur in a region separate from the TrP causing these phenomena. The phenomena usually appear in the same general area to which that TrP refers pain

prevelence 200 asymptomatic young adults

with latent TrPs found on 54% of males and 45% of females