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myofascial trigger point
A well localized point of tenderness with radiation of pain to specific zones. Myofascial trigger points are diagnostic criteria for myofascial pain syndrome & fibromyalgia syndrome.
Etiology:
1) muscle hyperirritability
2) muscle strain
a) mechanical stresses
1] structural asymmetry
a] leg-length discrepancy
b] pelvic asymmetry
c] short humerus
2] poor posture
3] prolonged immobilization
b) nutritional deficiency
c) endocrine disorders, especially thyroid
d) emotional stress/distress
e) sleep disturbance
Epidemiology:
1) up to 50% of normal population
2) male:female ratio 1:1
Clinical manifestations:
1) some trigger points have associated epiphenomena
- sternocleidomastoid
a) lacrimation
b) rhinorrhea
2) pain & dysfunction specific to the affected muscle
3) palpation of the trigger point reproduces or accentuates the pain
4) commonly encountered trigger points
a) center of a muscle belly (most common)
- paravertebral trigger points, associated with low back pain
b) costosternal junction
c) xiphoid process
d) ligamentous & tendinous insertions
e) fascia
f) fatty areas
5) referral of pain (see myofascial pain syndrome)
Related
fibromyalgia syndrome (fibromyositis, fibrositis)
myofascial pain syndrome
trigger point injection
References
- nlmpubs.nlm.nih.gov/hstat/ahcpr/
- 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, 1957