Myofascial Pain Syndrome

1. Myofascial Pain Syndrome
Ade Wijaya, MD – April 2019

2. Outline:
• Introduction
• Definition
• Etiopathogenesis
• Precipitating factors
• Clinical features
• Clinical signs
• Electrophysiology
• Management
• Summary

3. Introduction
• Underdiagnosed & undertreated
• Musculoskeletal pain, limited mobility, weakness, and
referred pain
• Myofascial trigger points
• Prevalence:
- 30-93% of all musculoskeletal pain
- 46.1 + 27.4 % overall

4. Definition
“ A noninflammatory disorder of musculoskeletal origin,
associated with pain and muscle stiffness, characterized by the
presence of hyperirritable palpable nodules in the skeletal
muscle fibers which are termed “Myofascial trigger points”

5. Etiopathogenesis

6. Perpetuating Factors

8. Clinical Features
• Acute and chronic
• Visceral and somatic
• Maybe accompanied by sensory symptoms
• Various symptoms

9. Clinical Signs
• Tender points
• Jump sign: pressure on the spot can cause the patient to react with a spontaneous
movement or exclamation
• Pain reproduction: by pressure on the tender points
• Local twitch response: by vigorously snapping palpation on myofascial trigger points
• Referred pain
• Restricted range of motion
• Weakness
• Recruitment disruption
• Associated phenomena: autonomic, proprioceptive, balance and tinnitus

10. Electrophysiology
• Low amplitude
• Intermittent high amplitude
• Increase endplate noise intensity

11. Management
• Manual therapies
• Noninvasive nonmanual therapies
• Invasive therapy: dry needling, acupuncture, local anesthetic
injections
• Medication (paracetamol, NSAIDs, weak opioids,
thiocolchicoside)
• Indentify and treat the underlying causes or the
perpetuating factors

12. Summary
• Myofascial pain is common
• Frequenty underdiagnosed and undertreated
• Various symptoms
• Myofascial trigger points
• Management: multimodal