Cervical Myofascial Pain

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Cervical Myofascial Pain originates from the vertebral spine in the neck correlating to muscle and its surrounding fascia (sheath of connective tissue supporting or binding together internal organs or parts of the body.). The diagnosis of this syndrome in clinical, with no confirmatory laboratory tests available. Thus, myofascial pain in any location is characterized on examination by the presence of trigger points located in skeletal muscle. In the cervical spine, the muscles most often implicated in myofascial pain are the trapezius, levator scapulae, rhomboids, supraspinatus, and infraspinatus. A trigger point is defined as a hyperirritable area located in a palpable taut band of muscle fibers. According to Hong and Simon's recent review on the pathophysiology and electrophysiologic mechanisms of trigger points, the following observations help to define them further:

• Trigger points are known to elicit local pain and/or referred pain in a specific recognizable distribution.
• Palpation in a rapid fashion (ie, snapping palpation) may elicit a local twitch response (LTR), a brisk contraction of the muscle fibers in or around the taut band. The LTR also can be elicited by rapid insertion of a needle into the trigger point.
• Restricted range of motion (ROM) and increased sensitivity to stretch of muscle fibers in a taut band are noted frequently.
• The muscle with a trigger point may be weak because of pain. Usually, no atrophic change is observed.
• Patients with trigger points may have associated localized autonomic phenomena (eg, vasoconstriction, pilomotor response, ptosis, hypersecretion).
• An active myofascial trigger point is a site marked by generation of spontaneous pain or pain in response to movement. This phenomenon is in contrast to the case of latent trigger points, which may not produce pain until they are compressed.

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eMedicine – http://emedicine.medscape.com/article/305937-overview





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