tkgoodspirit

PAGE TWO

Pathogenesis (development of disease)

There are several proposed histopathologic mechanisms to account for the development of trigger points and subsequent pain patterns, but scientific evidence is lacking. Many researchers agree that acute trauma or repetitive microtrauma may lead to the development of a trigger point. Lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems may all predispose to the development of microtrauma. Occupational or recreational activities that produce repetitive stress on a specific muscle or muscle group commonly cause chronic stress in muscle fibers, leading to trigger points. Examples of predisposing activities include holding a telephone receiver between the ear and shoulder to free arms; prolonged bending over a table; sitting in chairs with poor back support, improper height of arm rests or none at all; and moving boxes using improper body mechanics.

Acute sports injuries caused by acute sprain or repetitive stress (e.g., pitcher's or tennis elbow, golf shoulder), surgical scars, and tissues under tension frequently found after spinal surgery and hip replacement may also predispose a patient to the development of trigger points.

Clinical Presentation

Patients who have trigger points often report regional, persistent pain that usually results in a decreased range of motion of the muscle in question. Often, the muscles used to maintain body posture are affected, namely the muscles in the neck, shoulders, and pelvic girdle, including the upper trapezius, scalene, sternocleidomastoid, levator scapulae, and quadratus lumborum. Although the pain is usually related to muscle activity, it may be constant. It is reproducible and does not follow a dermatomal or nerve root distribution. Patients report few systemic symptoms, and associated signs such as joint swelling and neurologic deficits are generally absent on physical examination.

In the head and neck region, myofascial pain syndrome with trigger points can manifest as tension headache, tinnitus, temporomandibular joint pain, eye symptoms, and torticollis. Upper limb pain is often referred and pain in the shoulders may resemble visceral pain or mimic tendonitis and bursitis. In the lower extremities, trigger points may involve pain in the quadriceps and calf muscles and may lead to a limited range of motion in the knee and ankle. Trigger-point hypersensitivity in the gluteus maximus and gluteus medius often produces intense pain in the low back region.

Evaluation and Treatment for Trigger Point pain.

No laboratory test, imaging study, or interventional modality such as electromyography or muscle biopsy has been established for diagnosing trigger points.


Predisposing and perpetuating factors in chronic overuse or stress injury on muscles must be eliminated, if possible. Pharmacologic treatment of patients with chronic musculoskeletal pain includes analgesics and medications to induce sleep and relax muscles. Antidepressants, neuroleptics, or nonsteroidal anti-inflammatory drugs are often prescribed for these patients.

Nonpharmacologic treatment modalities include acupuncture, osteopathic manual medicine techniques, massage, acupressure, ultrasonography, application of heat or ice, diathermy, transcutaneous electrical nerve stimulation, ethyl chloride Spray and Stretch technique, dry needling, and trigger-point injections with local anesthetic, saline, or steroid. The long-term clinical efficacy of various therapies is not clear, because data that incorporate pre- and post-treatment assessments with control groups are not available.

The Spray and Stretch technique involves passively stretching the target muscle while simultaneously applying dichlorodifluoromethane-trichloromonofluoromethane (Fluori-Methane) or ethyl chloride spray topically. The sudden drop in skin temperature is thought to produce temporary anesthesia by blocking the spinal stretch reflex and the sensation of pain at a higher center. The decreased pain sensation allows the muscle to be passively stretched toward normal length, which then helps to inactivate trigger points, relieve muscle spasm, and reduce referred pain.


Okay, Done! Go rest now! LOL Thanks guys for always "bearing" with me and my long posts.
Love you,
TK

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"We must be the change we wish to see in the world"
Mahatma Gandhi