Myofascial Pain Syndrome: (Trigger-Points)

Presentation

In myofascial pain syndrome, the patient, who is generally 25 to 50 years of age, will be troubled by the gradual onset of localized or regional unilateral fibromuscular pain that at times can be immobilizing. There may be a history of either acute strain or predisposing activities such as holding a telephone receiver between the ear and shoulder to free the arms, prolonged bending, poor postural habits, repetitive motions, and heavy lifting using poor body mechanics. The areas most commonly affected are the axial muscles, used to maintain posture, which include the posterior muscles of the neck and scapula and the soft tissues lateral to the thoracic and lumbar spine.

Careful examination of the painful region will reveal one or more trigger points, which, when firmly pressed with an examining finger, will cause the patient to wince, cry out, or jump with pain. The underlying muscle may contain a small (2–5 mm) firm knot, nodule, or taut band of muscle fibers that produces the exquisitely tender trigger point and reproduces the pain of the patient’s chief complaint. Pain is often referred in a radicular pattern that may mimic the pain of cervical or lumbar disc herniation.

The patient with fibromyalgia, on the other hand, has widespread bilateral, symmetric musculoskeletal pain, which is associated with multiple tender points on palpation that do not cause any radiation of pain. This patient is often depressed or under emotional or physical stress and may have associated chronic fatigue with disturbed sleep, irritable bowel syndrome, cognitive difficulties, headache, morning stiffness, and sensations of numbness or swelling in the hands and feet. Other comorbid conditions might include irritable bladder symptoms, temporomandibular joint syndrome, myofascial pain syndrome, restless leg syndrome, and affective disorders. Cold or hot weather may be one of the precipitating causes of pain.

In both syndromes, most affected patients are women. Also, the pain is nonarticular, and there are no abnormal vital signs and no swelling, erythema, or heat over the painful areas .