Myofascial Pain

Syndrome
History
History
Muscular Rheumatism
Fibrositis
Fibromyalgia
Myofascitis
Myofascial Pain
Myofascial Pain Syndrome
Definition
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
Myofascial
Trigger point
Trigger point
Local tenderness in skeletal muscle or
fascia
Hyperirritable
Low pain pressure threshold
Produce pain, ANS, local twitch
Epidemiology
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
Symptoms and Signs
Pain
Autonomic phenomena
Myofascial TrP
Pain
Pain
Most common presenting symptoms
Regional Bizarre Referred pain pattern
Duration and severity
Autonomic phenomena
Autonomic phenomena
Vasomotor disturbance
Sweating, lacrimation, coriza
Salivation
Pilomotor erection
Propioceptive disorder
tinnitus
Stress & Tension Sleep disorder
Chr. Micro trauma
-poor postural
-repetitive motion
Macro trauma
-sudden impact
-injury
Muscle deficiency
-general decondition
Systemic influences
-endocrine imbalance
-nutritional def.
Post op influences
-immobility
-spasm
Neurogenic influence
-secondary to n root compression
Pathophysiologic
Pathophysiologic
mechanism of
mechanism of
TrP
TrP
Energy crisis theory
Micro/macro injury to muscle; poor
posture, CTD, injury
pathologic actin-myosin complex
Increase sensitivities of muscle nociceptor
Physical Examination
Physical Examination
General PE
TrP examination
Flat palpation
Snapping palpation
Pincer(grasping) palpation
TrP
TrP
palpation
palpation
Local twitch response
Reproducible refer pain
Autonomic phenomenon
Weakness and restrict motion
Laboratory Finding
Laboratory Finding
No specific lab for diagnosis
Use for rule out other disease
Clinical criteria
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
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
Classification of MPS
Acute MPS(<2 mths)
Subacute MPS(2 6 mths)
Chronic MPS
Natural course
Natural course
Spontaneous recovery
Persistence without progression
Additional TrP and chronicity
Treatment
Treatment
Goal
1.TrP inactivation
2.Prevention of recurrence
3.Correction of perpetuating factors
Two step of treatment
1.local treatment
2.Correction of perpetuating factors
Prognosis
Prognosis
Correct diagnosis
Early and proper treatment
Acute MPS good prognosis
Local treatment
Local treatment
TrP injection
Massage
Heat
Acupuncture
Etc.
No single standard treatment
TrP
TrP
injection
injection
Technique
Circular fan like technique
multiple needle entry technique
Agents
Agents
local anesthetic agents
steroids
saline
botulinum toxin
Effects of
Effects of
TrP
TrP
injection
injection
Mechanical effect
Chemical effect
Contraindication of
Contraindication of
TrP
TrP
injection
injection
Acute trauma
Bleeding tendency
Agents allergy
infection
Massage
Therapeutic heat
Electrotherapy
Perpetuating factors
Perpetuating factors
Mechanical factors
poor posture, structural abnormal
Systemic factors
vitamin deficiency
hypothyroidism
Psychological factors
Single muscle MPS
Single muscle MPS
Trapezius muscle
Infraspinatus muscle
Quadratus lumborum
Gastrocnemius muscle
Trapezius
Trapezius
muscle
muscle
Most common myofascial TrP
Upper > lower > middle
D/Dx temporal headache, c spondylosis
Associate TrP; levator scapulae,
supraspinatus, rhomboid
Infraspinatus
Infraspinatus
muscle
muscle
S/S; shoulder pain, limit ROM
D/Dx; GH jt arthritis, frozen shoulder,CSR
Associate TrP; supraspinatus, teres minor,
deltoid
Quadratus
Quadratus
lumborum
lumborum
Most common LBP caused by muscle
D/Dx SI jt dysfunction, trochanteric
bursitis, HNP
Associate TrP; G. minimus(sciatica pain)
Gastronemius
Gastronemius
muscle
muscle
Medial head > lateral head
D/Dx, S1 radiculopathy, compartment
syndrome
Associate TrP; soleus, hamstrings