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myofascial pain syndrome
Localized musculoskeletal pain & tenderness in association with trigger points.
Etiology:
1) may follow trauma or overuse
2) may follow state of prolonged contraction of a muscle or muscle group
a) reading or writing at a desk
b) working at a computer
3) may be associated with osteoarthritis in the neck or lower back
Clinical manifestations:
1) pain is deep & aching & may be accompanied by burning
2) myofascial trigger points are diagnostic feature
3) pain almost always involves the posterior neck, low back, shoulders & chest
4) referral of pain originating from occiput or trapezius trigger points (see fibromyalgia) may result in persistent headaches
5) trigger points in paravertebral areas, may refer to buttocks
6) gluteal trigger points may refer to the posterior aspect of the leg mimicking sciatica
7) infraspinatus trigger point may produced pain down the outside of the arm to the hand
Complications:
- may evolve into fibromyalgia syndrome
- risk factors
a) anxiety
b) depression
c) non-restorative sleep
d) fatigue
Management:
1) trigger point injections
2) massage
3) ultrasound
4) acupuncture may be helpful
5) osteopathic manipulation may be helpful
6) pharmaceutical agents
a) NSAIDs
b) muscle relaxants
c) tricyclic antidepressant
d) opiates if other agents & treatment modalities not effective
7) patient education
a) prevent muscle stresses related to work & recreation
b) good posture & proper resting positions
c) prognosis is good
Related
fibromyalgia syndrome (fibromyositis, fibrositis)
myofascial pain
myofascial pain dysfunction (MPD) syndrome
myofascial trigger point
General
muscular disease; myopathy
syndrome
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 787-89
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, 1955-57