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myofascial pain
A large group of muscle disorders characterized by the presence of hypersensitive points, called trigger points.
Etiology:
1) trauma
2) risk factors: sedentary lifestyle
- myofascial pain syndrome
3) other contributing, postulated factors
a) abnormal stresses on muscles from
1] sudden stress on shortened muscles
2] leg-length discrepancies
3] skeletal asymmetry
b) poor posture
c) static position for a prolonged period of time
d) anemia
e) hypokalemia
f) hypocalcemia
f) nutritional deficiencies
1] iron deficiency
2] vitamin C deficiency
3] thiamine deficiency
4] vitamin B6 deficiency
5] vitamin B12 deficiency
g) chronic infection
h) sleep deprivation
i) radiculopathy
j) depression
k) hypothyroidism
i) hyperuricemia
j) hypoglycemia
Epidemiology:
1) common
2) no racial or sexual bias
3) can be found in persons of all ages, even infants
4) incidence increases with age into middle age
Pathology:
- trigger points, within one or more muscles &/or the investing connective tissue associated with signs/symptoms
Clinical manifestations:
1) pain
a) local or referred pain
b) dull, aching or burning pain
c) pain may be exacerbated by
- physical activity
- pressure on involved tissue
- cold exposure
- psychosocial stress
- infection
d) pain may be alleviated by
- mild exercise
- gentle stretching
- massage
- moist heat
- brief rest after activity
2) muscle spasm
3) muscle tenderness, muscle stiffness
a) one finger points of tenderness
b) tensing of muscle may increase tenderness [2]
4) limited range of motion
5) muscle weakness without atrophy
6) occasionally autonomic dysfunction
7) popping & clicking
8) local twitch response (LTR) in the affected muscle
9) trigger points, over 70% correspond to acupuncture points
10) nerve entrapment may cause paresthesia, numbness
Laboratory:
1) no specific laboratory tests essential, but some listed below may be helpful
2) complete blood count for anemia
3) erythrocyte sedimentation rate (ESR)
4) serum chemistry profile
a) serum K+ for hypokalemia
b) serum Ca+2, serum albumin for hypocalcemia
c) serum uric acid for hyperuricemia
d) serum glucose for hypoglycemia
5) iron studies for iron deficiency
6) ascorbate in blood for vitamin C deficiency
7) serum thiamine for thiamine deficiency
8) serum vitamin B6 for vitamin B6 deficiency
9) serum vitamin B12 for vitamin B12 deficiency
10) serum folate for folate deficiency
11) serum TSH for hypothyroidism
Special laboratory:
- electromyography
a) spontaneous electrical activity over trigger points
b) lowered skin resistance to electrical current over trigger points compared to surrounding tissue
Radiology:
- imaging studies are useful only to rule out other sources of pain
Complications:
1) not fatal condition
2) significant reduction in quality of life
3) major cause of time lost from work
Differential diagnosis:
- neuropathic pain
Management:
1) physical therapy, occupational therapy
2) trigger point injections
3) acupuncture may be helpful
4) osteopathic manipulation may be helpful
5) pharmaceutical agents
a) NSAIDs
b) muscle relaxants
c) tricyclic antidepressant
d) opiates if other agents & treatment modalities not effective
Specific
myofascial pain dysfunction (MPD) syndrome
myofascial pain syndrome
trigeminal neuralgia (tic douloureux)
General
musculoskeletal pain
References
- emedicine: Myofascial pain
http://emedicine.medscape.com/article/313007-overview
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013
- Sharp HT.
Myofascial pain syndrome of the abdominal wall for the busy clinician.
Clin Obstet Gynecol. 2003 Dec;46(4):783-8. Review.
PMID: 14595219