Myofascial pain syndrome

1. Myofascial
pain
syndrome

2. Relevance of the problem
Of all patients with dorsopathies
40-45% of patients have
MPS in isolated form.
Another 40% have combined pathology.
However, the diagnosability of this disease
remains low.

3. Definition
MFPS (MPS) is
chronic pain
syndrome in which
different parts of the body
local or
segmental pain,
but a pathognomonic sign
are myofascial trigger zones.
An active trigger point is an area of involuntary spasm
of muscle fibers that is painful on palpation.

4. Stages of myofascial pain
syndrome
Stage I (latent myogenic trigger point) – there is no
local pain at rest, it is provoked by pressure or
stretching of the muscle, referred pain is not caused.

5. Stages of myofascial pain
syndrome
II (active trigger point with
regional muscle-tonic reactions) – spontaneous
a nagging pain is experienced
in the entire muscle, in the composition
which has
Local muscular
hypertonicity .
Palpation causes a typical
referred pain in neighboring areas, often along the
muscle.

6. Stages of myofascial pain
syndrome
III (active trigger point with generalized muscle-
tonic reactions) – diffuse
severe pain in a muscle group
at rest, worsening with any
movement. Muscle palpation
accompanied by generalization
soreness and sharp
increasing tone not only
agonist muscles , but also antagonists.

7. Causes of MFPS
1. Static muscle tension
2. Overload of untrained muscles
3. Muscle hypothermia
4. Muscle stretching with subsequent spasm
5.Anomalies in the structure of the musculoskeletal skeleton
6. Mental factors
7. Long-term immobilization of the muscle
8. Direct compression of the muscle
9. Internal diseases
organs and joints
10. Direct bruise
muscles

8. Pathogenesis of MPS

9. Pathogenesis of MPS
As a result, the resulting vicious circle includes muscle
spasm, pain, local ischemia, degenerative changes,
which self-support each other, reinforcing the root
cause of pathological changes
Excitation of
nociceptive neurons
causes reflex
activation of motor
neurons
Transmission of pain excitation
Protective muscle tension (spasm) caused by a pain
impulse

10. Clinical picture of MPS.
 - pain has its own distribution pattern (specific pattern)
and does not correspond to the dermatomyotome ,
sclerotomy , myotomal distribution of innervation;
 - pain reflected from myofascial trigger points are non-
segmental in nature;
 - pain is localized deep in the muscle tissue;
 -pain can vary in intensity;
 - pain can occur at rest or only with movement, pain
intensifies with compression or puncture of the trigger
point with an injection needle;
 - pain can appear as a result of obvious muscle tension or
gradually with chronic muscle overload.

11. Clinical picture of MPS
 The presence of a dense palpable muscle cord on the
superficial layers of muscles.
 Presence of local convulsive
answer is an incoming reduction
those muscle fibers of a tight cord,
which are directly related to
myofascial trigger point.
 The presence of a “jumping symptom” - when pressing on
the myofascial TT, the patient experiences an involuntary
movement (shudder) of the body and an “ algic ” grimace.

12. Clinical picture of MPS
 Skin manifestations of MFPS - panniculosis .
Moreover, in the area of referred pain, vegetative
manifestations may also occur in the form of changes
in sweating, skin color, and hypertrichosis (rarely).
 Emotional manifestations – comorbid depressive and
anxiety disorders, especially in the chronic course of
MFPS.

13. Diagnostic criteria for MFPS
Large criteria (at least 5):
 complaints of regional pain
 palpable “tight” muscle band
 area of increased sensitivity in the area of the “tight”
cord
 characteristic pattern of referred pain or sensory
disturbances
 limitation of range of motion

14. Diagnostic criteria for MFPS
Minor criteria (at least 1 out of 3):
 reproducibility of pain or sensory disturbances upon
palpation of the myofascial TT
 local contraction of the affected muscle upon
palpation of the myofascial TT or its injection
 reducing pain when stretching a muscle or therapeutic
blockade.

15. Differential diagnosis
 The differential diagnosis of myofascial pain syndrome
is carried out with the main pathological conditions
accompanied by muscle pain, primarily with
polymyalgia rheumatica and fibromyalgia .

16. MPS of the sternocleidomastoid muscle
Referred pain - in the forehead, in the buccal and
temporal areas, in the orbit. Sometimes the pain
spreads in a “helmet” pattern.

17. MPS scalene muscles
 Referred pain spreads
narrow stripes in front
and down to the pectoralis major
muscle, and also radiates
on the back surface
upper limb,
up to the index finger
finger

18. MFPS of the pectoralis minor muscle
 Often a source
chest pain and unpleasant
sensations in the sternum area.
 Pain does not increase with
movements, by localization
corresponds to pain in ischemic heart disease ,
therefore often not associated with
musculoskeletal dysfunction.
 Provoking factors
are the presence of ischemic heart disease, trauma in the area
sternum and ribs.

19. MFPS of the pectoralis major muscle
Activation of the TT occurs when lifting heavy objects,
especially in front of you, when working
with tight pliers, with hand load
in abduction position, with
long stay with
lowered shoulder girdles , that
leads to muscle contraction.

20. MPS of the trapezius muscle
If the trigger point is localized in the upper part of the
muscle, then the pain spreads along the side of the neck, as
well as in the ear, sometimes in the temporal region.
In the case of TT localization in the middle
departments the pain spreads
along the spine, in
interscapular area and
superolateral surface
shoulder From the lower sections -
neck area, above and
interscapular region.

21. MPS of the deltoid muscle
Referred pain -
in the front, middle
and posterior regions
muscles.

22. MPS of the
latissimus dorsi
muscle
Referred pain is localized in the
lower corner of the scapula,
adjacent to the midline.
Sometimes spreads to the back
of the shoulder and down the
medial surface of the arm to 4-
5 fingers

23. MPS of the erector spinal muscle
Referred pain
localized from
scapular region
to the bottom
buttocks.

24. MPS of the quadratus lumborum muscle
Referred pain is localized along the lateral border of the
iliac crest and to the greater trochanter of the femur
with superficial
location of trigger
points, and when they are deep
location - in the region
sacroiliac
joints deep in the buttocks.

25. MPS of the piriformis muscle
Referred pain is localized in the sacroiliac region, in the
buttock, along the back surface of the hip joint.
Sometimes it hurts
distributed by
to proximal
sections of the posterior
parts of the thigh.

26. MPS of the gluteus minimus muscle
Referred pain is localized to the lower lateral buttock,
lateral thigh and knee, and lateral calf
all the way down to the ankle. Sometimes
pain is localized
in the depths of the buttock, back
thigh surface and
shins, as well as behind
knee

27. MPS of the quadriceps femoris muscle
 Referred pain is localized in various areas along the
anterior and lateral surface of the thigh, up to the
patella and popliteal fossa.

28. MPS of the gastrocnemius muscle
 Referred pain is localized to the calf muscle without
impairing mobility or weakening muscle strength.

29. Treatment of MPS
muscle relaxation , anti-inflammatory effect,
and elimination of the pathological motor
stereotype should be achieved .

30. Treatment of MPS
 Drug therapy
Analgesics ( Katadolon )
NSAIDs ( Meloxicam , Diclofenac , etc. )
Muscle relaxants ( Mydocalm , sirdalud , baclofen )
Antidepressants ( adjuvant analgesics)
In case of an acute attack, drug therapy should
begin from the moment the patient consults a
doctor!

31. Treatment of MPS
5-7 days after the pain has subsided, you can begin
 Manual therapy
 Physiotherapy ( electroneurostimulation ,
acupuncture, warming)
 Psychological correction

32. Methods of manual treatment of pain
associated with myofascial disfunction .
 The most effective is post-isometric relaxation of the affected
muscle.
 Puncture of trigger points with an injection needle with or
without the administration of a local anesthetic, NSAID,
corticosteroid, botulinum toxin (dry puncture).
 Acupressure (ischemic compression)