Myofascial pain is characterized by pain referred from active trigger points. A myofascial trigger point is a hyperirritable locus, which may be palpable as an exquisitely tender, taut band within skeletal muscle.
Compression at those points elicits a characteristic and reproducible pattern of referred pain remote from the location of the tender trigger point. Often, the 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.
Myofascial pain may be abrupt in onset (perhaps 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.
Needling of the trigger point and injection with local anesthetic and sometimes steroid, followed by passive stretching, may be performed. Hot packs are applied after either modality.
Physical therapy,application of moist heat, ultrasound, electrical stimulation, or iontophoresis are useful in controlling the symptoms. Other therapies include nonsteroidal anti-inflammatory drugs, muscle relaxants, and a bedtime tricyclic antidepressant.
Stress-reduction therapy including biofeedback, hypnosis, and behavior modification also may be used.
Cervical Myofascial Trigger Points
Muscle: Trepezius
Area of referred pain: Neck, shoulder, and temporal region
Muscle: Splenius capitis and cervicis
Area of referred pain: Head, occiput, shoulder and neck; vision may be blurred
Muscle: Posterior neck muscles, semispinalis capitis and cervicis and multitifidi
Area of referred pain: Suboccipital area, neck, and shoulders
Muscle: Levator scapulae
Area of referred pain: Angle of the neck and along the vertebral body of the border of the scapula
Muscle: Scalene
Area of referred pain: Chest, upper-central border of the scapula, and along the arm.
Muscle: Supraspinatus
Area of referred pain: Posterior neck and subocciptal area of the deltoid, deep in the shoulder joint, and the front and lateral aspects of the arm and
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