Myofascial Pain Syndrome

History • • • • • •

Muscular Rheumatism Fibrositis Fibromyalgia Myofascitis Myofascial Pain Myofascial Pain Syndrome

Definition MPS; “Pain and/or autonomic phenomenon caused by active trigger point in skeletal muscles or fascia” Myofascial trigger point(TrP) “A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band”

Myofascial Trigger point • Local tenderness in skeletal muscle or fascia • Hyperirritable • Low pain pressure threshold • Produce pain, ANS, local twitch

Epidemiology • • • • •

Female ; Male, 2.4:1 High prevalence in 31-35 yr Postural muscles Sedentary worker > Hard worker Latent TrP > Active TrP

Symptoms and Signs • Pain • Autonomic phenomena • Myofascial TrP

Pain • Most common presenting symptoms • Regional Bizarre Referred pain pattern • Duration and severity

Autonomic phenomena • • • • • •

Vasomotor disturbance Sweating, lacrimation, coriza Salivation Pilomotor erection Propioceptive disorder tinnitus

Stress & Tension

Sleep disorder

Chr. Micro trauma -poor postural -repetitive motion

Neurogenic influence -secondary to n root compression

Macro trauma -sudden impact -injury Post op influences -immobility -spasm

Systemic influences -endocrine imbalance -nutritional def.

Muscle deficiency -general decondition

Pathophysiologic mechanism of TrP • Energy crisis theory • Micro/macro injury to muscle; poor posture, CTD, injury • “pathologic actin-myosin complex” • Increase sensitivities of muscle nociceptor

Physical Examination • General PE • TrP examination – Flat palpation – Snapping palpation – Pincer(grasping) palpation

TrP palpation • • • •

Local twitch response Reproducible refer pain Autonomic phenomenon Weakness and restrict motion

Laboratory Finding • No specific lab for diagnosis • Use for rule out other disease

Clinical criteria Major criteria 1. Regional pain 2. Pain or alteration of sensation in referred pain zone (as MPS pattern) 3. Taut band palpation 4. Decrease ROM

Minor criteria 1. Pain complaint by pressure on a nodule 2. Local twitch response 3. Injection or stretching exercise can decrease pain

Fischer criteria • Tender point measured by algometer has lower PPT at least 2kg/cm2 than the different side • Tender point compression can reproduce the symptoms • Pain reduction by TrP injection or other treatment

Classification of MPS • Acute MPS( lower > middle D/Dx temporal headache, c spondylosis Associate TrP; levator scapulae, supraspinatus, rhomboid

Infraspinatus muscle • S/S; shoulder pain, limit ROM • D/Dx; GH jt arthritis, frozen shoulder,CSR • Associate TrP; supraspinatus, teres minor, deltoid

Quadratus lumborum • Most common LBP caused by muscle • D/Dx SI jt dysfunction, trochanteric bursitis, HNP • Associate TrP; G. minimus(sciatica pain)

Gastronemius muscle • Medial head > lateral head • D/Dx, S1 radiculopathy, compartment syndrome • Associate TrP; soleus, hamstrings