Cervical myofascial pain originates from neck muscle and surrounding fascia and is characterized by the presence of trigger points [hyperirritable areas located in a palpable, taut band of muscle]
Myofascial pain syndrome is said to constitute the largest group of unrecognized and among the most commonly overlooked causes of chronic pain and disability.
Often, the Cervical myofascial pain is described as steady, deep, and aching in quality, although it is not uncommon for patients to use words like burning or crushing.
The pain patterns are not limited to a specific dermatome or peripheral nerve segment. Pain of myofascial origin is essentially a diagnosis of exclusion, as the character of the pain may mimic other cervical pathology.
The muscles most often implicated in cervical myofascial pain are the trapezius, levator scapulae, rhomboids, supraspinatus, and infraspinatus.
Myofascial pain has predominance among women.
Causes of Cervical Myofascial Pain
Overuse of the muscles by repetitive use of the upper limb or trauma to muscles may lead to cervical myofascial pain. Lack of proper furniture in desk jobs, endocrine dysfunction, chronic infections, nutritional deficiencies, poor posture, and psychological stress may also be responsible.
Cervical myofaccial pain may be abrupt in onset (after an injury) or of more gradual onset (from chronic over utilization of muscles).
Psychogenic stress, viral illness, visceral disease, exposure to cold or damp weather, strenuous exercise, or prolonged tension of the involved muscle may precipitate or exacerbate a myofascial pain syndrome.
Trigger points commonly responsible for pain referred to the cervical area are located within several muscle groups.
Cervical Myofascial Pain Trigger Points
|Muscle||Area of referred pain|
|Trapezius||Neck, shoulder, and temporal region|
|Splenius capitis and cervicis||Head, occiput, shoulder and neck; vision may be blurred|
|Posterior neck muscles, semispinalis capitis and cervicis and multitifidi||Suboccipital area, neck, and shoulders|
|Levator scapulae||Angle of the neck and along the vertebral body of the border of the scapula|
|Scalene||Chest, upper-central border of the scapula, and along the arm.|
|Supraspinatus||Posterior neck and subocciptal area of the deltoid, deep in the shoulder joint, and the front and lateral aspects of the arm.|
Presentation and Diagnosis of Cervical Myofascial Pain
Patient may give a history of trauma or repetitive activity but cervical myofascial pain can also be associated with poor posture, stress, or cold weather. Pain in in the neck can be associated with bump in the trapezius or cervical paraspinal muscles.
Pain may radiate into the upper extremities and may be accompanied by numbness and tingling in upper extremity. Pain may be accompanied by dizziness or nausea.
The pain may be relieved by massage or heat therapy.
Patients with cervical myofascial pain often present with poor posture. Trigger points or taut bands may be noted in trapezius, supraspinatus, infraspinatus, rhomboids, and levator scapulae muscles.
The diagnosis of cervical myofascial pain is clinical. There is no confirmatory laboratory tests available.
However investigations , to rule out any serious conditions may be needed. In case of trauma cervical x rays may be done to rule out the cervical instability.
Magnetic resonance imaging may be help to rule out problems in cervical spine and spinal canal. Common differential diagnoses of cervical myofascial pain are
- Cervical Disc Disease
- Cervical Spondylosis
- Cervical Sprain and Strain
- Rheumatoid Arthritis
- Thoracic Outlet Syndrome
Treatment of Cervical Myofascial Pain
Myofascial release techniques, massage, cervical stretch and stabilization are integral parts of this approach. The primary goal of physical therapy is to restore balance between muscles working as a functional unit. Postural retraining is crucial.
Trigger Point Injection
One of the most accepted means of treating myofascial pain besides physical therapy and exercise. Injection is performed most commonly with local anesthetic, although dry needling is equally effective.
Stretch and spray
This technique is performed using a vapocoolant spray applied to the affected muscle after it has been placed in passive stretch.
Ischemic compression involves application of sustained pressure on the trigger point. With muscle in a fully stretched position, press firmly on the trigger point with a thumb. Gradually increase the pressure as the pain lessens.
Non steroidal anti-inflammatory drugs are the drugs of choice for the initial treatment of myofascial pain. Ibuprofen, Indomethacin, naproxen, diclofenac and ketoprofen are commonly used drugs.
Opioid analgesics like tramadol can also be used.
Tricyclic antidepressants like amitriptyline are commonly used for chronic pain. They also help to treat assocoiated insomnia.
Cyclobenzaprine, baclofen, carisoprodol, tizanidine are commonly used muscle relaxants.
Gabapentin has been shown to be effective in treating myofascial and neuropathic pain.
With appropriate treatment the prognosis is generally good. Outcomes is better when treatment is initiated early.
Cervical myofascial pain is a treatable condition if the patient is educated on the condition and takes an active role in the recovery process. However, recurrence is a problem.
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