MSK IV Exam 1 (Myofascial Trigger Points)

(T/F) Sensitizing substances (inflam. soup) may also demyelinate local sensory nerves

True

(T/F) TrP may be the cause of central sensitization but it could also be the result of central sensitization

True

(T/F) after treating MTrP, you should also educate about pain neuroscience

True

The muscle is the primary source of pain for MTrP, what could be the etiology?

due to 1. repetitive mm overuse 2. acute muscle overload 3. repetitive minor muscle trauma *no other underlying med conditions

Since TrP can affect nociplastic pain, what should you do?

initiate, activate and maintain sensitization *not treating active or latent trigger points may lead to chronic pain

What are the sensory features of MTrP?

localized pain, referred pain, nociception (central sensitizaiton), peripheral sensitization

What are autonomic components of MTrP?

localized swelling, vasoconstriction/dilation, pilomotor activity (goosies), MTrP in cranium (tearing, nasal discharge, salvation)

What is Myofascial pain syndrome?

myalgic condition in which muscle and musculotendinous pain are the primary symptoms

What is the primary component of Myofascial Pain Syndrome?

myofascial trigger point (MTrP)

What does an active MTrP cause in the dorsal horn?

nociplastic changes in dorsal horn

What does lowering action potential threshold lead to?

peripheral sensitization (hyperalgesia)

What do you need to do after treating MTrP:

re-establish motor control *go back to movement-- break task down and work on components of task and mm recruitment *eccentrics rhythmic stabilization/synergisitc control, closed chain activities

What can treatment of MTrP lead to?

reduces nociplastic changes and reduces MTrP

What does compression of the local sensory nerves lead to?

results in ACh release without inhibition

What is latent trigger point?

same s/sx as an active TrP but pain ONLY with palpation hypersensitive spoint, taut band, referred pain

What are secondary source of dysfunction for myofascial pain syndrome?

-Joint mobility (OA) -Visceral conditions (endometriosis, interstitial cycitis, IBS, Dysmenorrhea, prostatis)

What are some examples of MTrP mimicking other pain?

-idiopathic neck pain -lateral epi -Chronic tension headache -shoulder pain -TMJ -Other

Why are MTrP a "triple" threat?

1. cause direct pain (primary source) 2. complicate pain patterns 3. mimic other pain

What are the 3 clinical signs that point toward Myofascial Trigger point?

1. hyperirritable spot 2. taut band 3. Referred pain (usually distinct referred pain pattern)

How many of the clinical signs do you need to rule as myofascial trigger point (MTrP)

2 out of 3 for it to be a positive trigger point

What are the 2 types of trigger points?

Active Trigger Point and Latent Trigger Point

Referred Pain Intensity + Size of pain area =

CNS more involved

What are other ways to treat latent trigger point?

Healthy NS, knowledge, exercise, diet, mental health (mediation)

What is an active trigger piont?

Reproduction of an sx experienced by the pt active pain without provocation ("thats my pain") -hypersensitive spot -Taut band -Referred pain initiated by the MTrP

In the picture, what is the palpation site and what do the red areas represent?

XX= palpation site (not necessarily a specific location but a suggestion) Red areas are most common referral areas for that specific muscle

What should be changed in someones diet to prevent MTrP?

avoid excess coffee, alcohol

What are 5 ways to treat MTrP?

botox, dry needling, manual manip, laser, TENS

When the trigger points motor component has compression of local blood supply, what does this lead to?

decrease ATP and increase Ca+

The trigger point- motor component starts with excessive motor activity at motor endplate (contraction knots), this leads to what?

compresses the local sensory nerves

What happens after ACh releases without inhibition in the trigger point motor component?

compression of local blood supply

What does a decrease ATP and increase Ca+ in the trigger point motor component lead to?

continuous muscle spasms

When palpating for a MTrP, what are you looking for?

taut band, nodular, (greater the hardness, greater the tenderness) patients pain and referred pain

What are the motor features of MTrP?

taut band, twitch response, weakness w/o atrophy, loss of reciprocal inhibition, EMG endplate noise, symp modulation

What are palpable symptoms?

tenderness, referred pain, motor dysfunction, autonomic characterisitics

When you are palpating a pt muscle to find MTrP, what happens when you identify the taut band?

there will be a report of pain (or other sensatino) away from the palpation site *other sensations are pain spreading to a distant area, deep pain, dull ache, tingling burning

What are confirmatory observations when treating potential MTrP?

visual or tactile twitch response, pain or alteration sensation on compression, EMG spontaneous electrical activity w/in taut badn