II. Pathophysiology

  1. Contrast Trigger Points with Tender Points which were part of the original Fibromyalgia diagnostic criteria
  2. Trigger Points are central to Myofascial Pain Syndrome
  3. Trigger Points are associated with generalized Muscle changes
    1. Tense skeletal Muscle bands
    2. Muscle shortening
    3. Muscle Weakness
    4. Decreased Muscle range of motion
  4. Trigger Point compression induces local and referred pain
    1. Compression of Trigger Point leads to local ischemia
    2. Ischemia leads to local inflammatory factor (Prostaglandin, kinin) release

III. Preparation

  1. Patient examined in relaxed position

IV. Signs

  1. See Trigger Point Locations
  2. Taut, ropy bands, knots or Nodules of Muscle fibers
    1. Surrounded by normal feeling Muscle
  3. Muscle tenderness to palpation
    1. Local twitch response to palpation ("jump sign")
    2. Involuntary shortening of fibrous Muscle band
  4. Trigger Points occur in predictable locations
    1. Trigger Points occur longitudinally along Muscle axis
    2. Trigger Points are consistent from patient to patient
    3. Axial Muscles (Posture) most commonly affected
  5. Pain Radiation
    1. Dull, aching, deep pain on Trigger Point palpation
    2. Predictable referred pain to distal reference zones
  6. Functional Disability
    1. Decreased range of motion
    2. Decreased flexibility on active and passive stretch
    3. Weakness of affected Muscle
  7. Trigger Point pain types
    1. Active Trigger Point
      1. Ongoing, persistent pain
      2. May activate satellite or secondary Trigger Points
    2. Latent Trigger Point
      1. Asymptomatic until palpated

V. Differential Diagnosis: Tender Point (Fibromyalgia)

  1. Specific, symmetrical localized points in Fibromyalgia
  2. Tender Points are associated with total body pain
  3. Tender Points not associated with referred pain

VII. Resources

  1. Trigger Point Physiology from Myopoint
    1. http://myopoint.com/network/physicians/myalgia.htm

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