Exam
Trigger Point
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Trigger Point
See Also
Myofascial Pain Syndrome
Trigger Point Locations
Trigger Point Injection
Pathophysiology
Trigger Points are central to
Myofascial Pain Syndrome
Trigger Points result in 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
Preparation for exam
Patient examined in relaxed position
Signs
See
Trigger Point Locations
Taut, ropy bands, knots or
Nodule
s 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
Trigger Points occur longitudinally along muscle axis
Trigger Points are consistent from patient to patient
Axial muscles (
Posture
) most commonly affected
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
Differential Diagnosis
Tender Point
(
Fibromyalgia
)
Specific, symmetrical localized points in
Fibromyalgia
Tender Point
s are associated with total body pain
Tender Point
s not associated with referred pain
Management
See
Myofascial Pain Syndrome
See
Trigger Point Injection
See
Stretch and Spray
See
Chronic Pain Management
Resources
Trigger Point Physiology from Myopoint
http://myopoint.com/network/physicians/myalgia.htm
References
Alvarez (2002) Am Fam Physician 65(4): 653-60 [PubMed]
Fomby (1997) Phys Sportsmed 25(2):67-75 [PubMed]
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