FINAL CASE PRESENTATION DDC PT '14

1. CervicalCervical
MyofascialMyofascial
PainPain
SyndromeSyndrome
Artemio L. Gordonas, Jr.
DDC PT- Intern '14

2. BACKGROUND
Pain attributed to muscle and its surrounding fascia is
termed myofascial pain, with cervical myofascial pain
thought to occur following either overuse or trauma
to the muscles that support the shoulders and neck.
In the cervical spine, the muscles most often
implicated in myofascial pain are the trapezius,
levator scapulae, rhomboids, supraspinatus, and
infraspinatus.

3. BACKGROUND
Myofascial pain in any location is characterized on
examination by the presence of trigger points located
in skeletal muscle. A trigger point is defined as a
hyperirritable area located in a palpable, taut band of
muscle fibers.

4. BACKGROUND
The primary concern for patients with cervical
myofascial pain is chronicity. Recurrence of
myofascial pain is a common scenario. Prompt
treatment prevents other muscles in the functional
unit from compensating and, consequently, producing
a more widespread and chronic problem. Migraine
headaches and muscle contraction headaches are
known to occur frequently in the patient with
myofascial pain.

5. DESCRIPTION
Myofascial pain syndrome is defined as a chronic,
regional pain syndrome. The hallmark classification of
MPS comprises the myofascial trigger points (MtrPs)
in a muscle which have a specific referred pattern of
pain. The trigger point is defined as a hyper-irritable
area in a tight band of muscle. The pain from these
points is described as dull, aching, and deep.

6. DESCRIPTION
Additional impairments from the trigger points include
decreased ROM when the muscle is being stretched,
decreased strength in the muscle, and increased pain
with muscle stretching. The trigger points may be
active (producing a classic pain pattern) or latent
(asymptomatic unless palpated).

7. ETIOLOGY
✔ overuse or trauma to the muscles
✔ motor vehicle accident
✔ performance of repetitive upper extremity activities

8. ETIOLOGY
Possible Causes of Trigger Points
✔ Chronic overload of the muscle
✔ Acute overload of the muscle
✔ Poorly conditioned muscles
✔ Postural stresses (such as sitting for prolonged
periods of time)
✔ Poor body mechanics

9. EPIDEMIOLOGY
Occurrence in the United States
➔ Myofascial pain is thought to occur commonly
in the general population. As many as 21% of
patients seen in general orthopedic clinics have
myofascial pain. Of patients seen at specialty
pain management centers, 85-93% have a
myofascial pain component to their condition.

10. EPIDEMIOLOGY
Sex- and age-related demographics
➔ Cervical myofascial pain occurs in both sexes,
but with a predominance among women.
Myofascial pain seems to occur more frequently
with increasing age until midlife. The incidence
declines gradually after middle age.

11. ANATOMY
Types of Tissue
● Skeletal muscle or "voluntary muscle"
● Smooth muscle or "involuntary muscle"
 Cardiac muscle is also an "involuntary muscle"
- Cardiac and skeletal muscles are "striated" in that
they contain sarcomeres that are packed into highly
regular arrangements of bundles.

12. ANATOMY
Skeletal (voluntary) muscle is further divided into two
broad types: slow twitch and fast twitch

13. Type I fibers
(red)
Type II a fibers
(red)
Type II b fibers
(white)
Contraction time
Slow Moderately
Fast
Very fast
Size of motor
neuron
Small Medium Very large
Resistance to
fatigue
High Fairly high Low
Activity Used for
Aerobic Long-term
anaerobic
Short-term
anaerobic
Maximum duration
of use
Hours <30 minutes <1 minute
Power produced Low Medium Very high
Note
Consume
lactic acid
Produce lactic acid
and Creatine
phosphate
Consume Creatine
phosphate

14. PHYSIOLOGY
There are three general types of muscle tissues:
➢ Skeletal muscle responsible for movement
➢ Cardiac muscle responsible for pumping blood
➢ Smooth muscle responsible for sustained contractions
in the vascular system, gastrointestinal tract, and other
areas in the body.

15. PHYSIOLOGY
Skeletal and cardiac muscles are called striated muscle because of
their striped appearance under a microscope, which is due to the
highly organized alternating pattern of A band and I band.

16. PHYSIOLOGY
Skeletal muscle contractions
1. ACTION
POTENTIAL
2. activating
voltage-gated
sodium channels
3. Ca2+ influx
4. activates
nicotinic
acetylcholine
receptors
7. T-tubules
(depolarizing)
6. activates
L-type
Voltage-dependent
calcium channels
5. Sarcoplasmic
Reticulum
release calcium
8. binds
to
troponin C
Myosin bind
to actin
10. ATP
binds to
myosin
(release actin)
Steps 9 and
10 repeat
CONTRACTION
CEASES
9. Myosin bind
to actin