Injection Technique for Splenius Cervicis Syndrome

Indications and Clinical Considerations

The splenius cervicis is susceptible to developing myofascial pain syndrome. Flexion–extension and lateral motion stretch injuries to the neck and upper back or repeated microtrauma secondary to jobs that require working overhead or looking to 1 side for long periods, such as painting ceilings or activities such as reading in bed or watching television while reclining on a couch, may result in the development of myofascial pain in the splenius cervicis muscle. The splenius cervicis muscles are also implicated in the evolution of dropped head syndrome commonly seen in Parkinson disease, and the injection technique described later may provide a modicum of symptomatic relief ( Fig. 26.1 ).

Myofascial pain syndrome is a chronic pain syndrome that affects a focal or regional portion of the body. The sine qua non of myofascial pain syndrome is the finding of myofascial trigger points on physical examination. Although these trigger points generally are localized to the regional part of the body affected, the pain of myofascial pain syndrome often is referred to other anatomic areas. This referred pain often is misdiagnosed or attributed to other organ systems, leading to extensive evaluations and ineffective treatment. Patients with myofascial pain syndrome involving the splenius cervicis often have referred pain into the occipital and temporal regions and circumferential pain that may mimic tension-type headache.

The trigger point is the pathognomonic lesion of myofascial pain and is thought to be the result of microtrauma to the affected muscles. This pathologic lesion is characterized by a local point of exquisite tenderness in affected muscle. Mechanical stimulation of the trigger point by palpation or stretching produces not only intense local pain but also referred pain. In addition to local and referred pain, there often is an involuntary withdrawal of the stimulated muscle, called a “jump sign.” This jump sign also is characteristic of myofascial pain syndrome.

Taut bands of muscle fibers often are identified when myofascial trigger points are palpated. In spite of this consistent physical finding in patients with myofascial pain syndrome, the pathophysiology of the myofascial trigger point remains elusive, although many theories have been advanced. Common to all of these theories is that trigger points are the result of microtrauma to the affected muscle. This microtrauma may occur as a single injury or as a result of repetitive microtrauma or chronic deconditioning of the agonist and antagonist muscle unit.

In addition to muscle trauma, a variety of other factors seem to predispose the patient to develop myofascial pain syndrome. The weekend athlete who subjects his or her body to unaccustomed physical activity may develop myofascial pain syndrome. The poor posture of someone sitting at a computer keyboard or watching television has also been implicated as a predisposing factor to the development of myofascial pain syndrome. Previous injuries may result in abnormal muscle function and predispose to the subsequent development of myofascial pain syndrome. All of these predisposing factors may be intensified if the patient also has poor nutritional status or coexisting psychological or behavioral abnormalities, including chronic stress and depression. The splenius cervicis muscle seems to be particularly susceptible to stress-induced myofascial pain syndrome.

Stiffness and fatigue often coexist with the pain of myofascial pain syndrome, increasing the functional disability associated with this disease and complicating its treatment. Myofascial pain syndrome may occur as a primary disease state or in conjunction with other painful conditions, including radiculopathy and chronic regional pain syndromes. Psychological or behavioral abnormalities, including depression, frequently coexist with the muscle abnormalities associated with myofascial pain syndrome, and treatment of these psychological and behavioral abnormalities must be an integral part of any successful treatment plan for myofascial pain syndrome.