Myofascial pain syndrome is a common chronicpain disorder that can affect various parts of the body. Myofascial pain syndrome is characterizedby presence of hyperirritable spots located in skeletal muscle called trigger points.A trigger point can be felt as a band or a nodule of muscle with harder than normal consistency.Palpation of trigger points may elicit pain in a different area of the body. This is calledreferred pain. Referred pain makes diagnosis difficult as the pain mimics symptoms of morewellknown common conditions. For example, trigger point related pain in the head andneck region may manifest as tension headache, temporomandibular joint pain, eye pain, ortinnitus.
Symptoms of myofascial pain syndrome includeregional, persistent pain, commonly associated with limited range of motion of the affectedmuscle. The pain is most frequently found in the head, neck, shoulders, extremities,and lower back. Trigger points are developed as a result ofmuscle injury. This can be acute trauma caused by sport injury, accident, or chronic muscleoveruse brought by repetitive occupational activities, emotional stress or poor posture.A trigger point is composed of many contraction knots where individual muscle fibers contractand cannot relax. These fibers make the muscle shorter and constitute a taut band a groupof tense muscle fibers extending from the
trigger point to muscle attachment. The sustainedcontraction of muscle sarcomeres compresses local blood supply, resulting in energy shortageof the area. This metabolic crisis activates pain receptors, generating a regional painpattern that follows a specific nerve passage. The pain patterns are therefore consistentand are well documented for various muscles. Treatment of myofascial pain syndrome aimsto release trigger points and return the affected muscle to original length and strength. Commontreatment options include: Manual therapy, such as massage, involvesapplication of certain amount of pressure to release trigger points. The outcome ofmanual therapy strongly depends on the skill
level of the therapist. The Spray and Stretch technique makes use of a vapor coolant to quickly decrease skintemperature while passively stretching the target muscle. A sudden drop in skin temperatureprovides a pain relief effect, allowing the muscle to fully stretch, and thus releasingthe trigger points. Trigger point injections with saline, localanesthetics or steroids are well accepted as effective treatments for myofascial triggerpoints. Dry needling insertion of a needle withoutinjecting any solution is reported to be as effective as injections.
Shoulder Pain and Common Shoulder Problems
Shoulder pain is a very common complaint responsiblefor millions of visits each year. After back pain, it’s the second most commonmusculoskeletal complaint. Shoulder pain can result from literally hundreds of causes.Nerves are ultimately responsible for signaling pain, and the shoulder is surrounded by arich network of nerves. Many are on their way to other sites in thebody. Sometimes pain or injury in one area of the body is actually felt in another area.This is sometimes called referred pain. Successful treatment of shoulder pain reallydepends on identifying the cause of your shoulder pain.In other words, an accurate diagnosis is the
most important thing.Pain in this anterior chest area certainly can have referred pain from heart, lungs,or GI tract. Certainly cervical issues can be referredto this region as well. Typically, shoulder mediated pain does notrefer to the anterior chest wall itself. Once we take away the pectoralis major tendonwe also see the pectoralis minor and also see a significant number of nerves that arecoming out of the cervical spine traveling behind the collar bone or clavicle on theirway down the arm along the chest wall. So it’s easy to imagine that pain in thisregion can result from referred pain from
this rich network of nerves traveling behindthe coracoid and pectoralis minor. Tightness of the pectoralis minor can alsoresult in shoulder impingement. Typically, impingement pain is in this anterioranterolateral area. But the most common cause of pain in thisregion in many patients’ and physicians’ perception is the rotator cuff.Here we see the anterolateral area after the deltoid has been taken away, and we see thesupraspinatus portion of the rotator cuff. The CA ligament which stands for coracoacromialligament, and this is a very important ligament as it completes the circle of the shoulder.This ligament is also not apparent on an Xray,
and when bone ossification of this ligamentoccurs, this typically is called a spur because that point appears to be out in space digginginto the rotator cuff which actually is a misnomer.Anterior shoulder pain where the biceps goes for a lot of people means biceps mediatedpain, but again this is a very nonspecific area of pain and a lot of different causescan be referred here. We can see a significant number of nervespassing by the area of the biceps on their way down the arm.And again, cervically mediated pain can be referred here, pain from other chest wallabnormalities, and certainly shoulder pathology
itself can also be referred as anterior shoulderpain. The other part that can result in interiorshoulder pain is a problem with the subscapularis which is the hidden part of the rotator cuffbecause it’s so often missed. Occult shoulder instability can also presentprimarily as anterior shoulder pain. As we move on to the posterior aspect of therotator cuff here we see the infraspinatus and the teres minor, and typically, pathologyhere will result in posterior shoulder pain. Again, posterior shoulder pain has a lot ofdifferent causes, tightness, muscular strain, referred pain again from the cervical spine,also referred pain in this region can come
from a pinched nerve in the shoulder likethe suprascapular nerve. Again we see a significant number of deepermuscles connecting the shoulder girdle to the remainder of the skeleton and a strainor sprain in any of these can result in pain in the upper back and posterior shoulder.So it’s important to see that the shoulder girdle fits within the overall skeletal systemand you can imagine if there’s abnormal curvature of the thoracic spine that might make theshoulder blade tilt forward further creating impingement and shoulder pain.So it’s important to evaluate all of these things and any evaluation of the shoulderincludes movement of the shoulder blade and