II. Pathophysiology
- Contrast Trigger Points with Tender Points which were part of the original Fibromyalgia diagnostic criteria
- Trigger Points are central to Myofascial Pain Syndrome
- Trigger Points are associated with generalized Muscle changes
- Tense skeletal Muscle bands
- Muscle shortening
- Muscle Weakness
- Decreased Muscle range of motion
- Trigger Point compression induces local and referred pain
- Compression of Trigger Point leads to local ischemia
- Ischemia leads to local inflammatory factor (Prostaglandin, kinin) release
III. Preparation
- Patient examined in relaxed position
IV. Signs
- See Trigger Point Locations
- Taut, ropy bands, knots or Nodules of Muscle fibers
- Surrounded by normal feeling Muscle
-
Muscle tenderness to palpation
- Local twitch response to palpation ("jump sign")
- Involuntary shortening of fibrous Muscle band
- Trigger Points occur in predictable locations
- Pain Radiation
- Dull, aching, deep pain on Trigger Point palpation
- Predictable referred pain to distal reference zones
- Functional Disability
- Decreased range of motion
- Decreased flexibility on active and passive stretch
- Weakness of affected Muscle
- Trigger Point pain types
- Active Trigger Point
- Ongoing, persistent pain
- May activate satellite or secondary Trigger Points
- Latent Trigger Point
- Asymptomatic until palpated
- Active Trigger Point
V. Differential Diagnosis: Tender Point (Fibromyalgia)
- Specific, symmetrical localized points in Fibromyalgia
- Tender Points are associated with total body pain
- Tender Points not associated with referred pain
VI. Management
VII. Resources
- Trigger Point Physiology from Myopoint