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. (See Etiology.)[1]
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 (see the image below). (See Etiology, Presentation, and Treatment.)
Schematic
of a trigger point complex of a muscle in longitudinal section. A: The
central trigger point (CTrP) in the endplate zone contains numerous
electrically active loci and numerous contraction knots. A taut band of
muscle fibers extends from the trigger point to the attachment at each
end of the involved fibers. The sustained tension that the taut band
exerts on the attachment tissues can induce a localized enthesopathy
that is identified as an attachment trigger point (ATrP). B: Enlarged
view of part of the CTrP shows the distribution of 5 contraction knots.
The vertical lines in each muscle fiber identify the relative spacing of
its striations. The space between 2 striations corresponds to the
length of 1 sarcomere. The sarcomeres within one of these enlarged
segments (ie, contraction knot) of a muscle fiber are markedly shorter
and wider than the sarcomeres in the neighboring normal muscle fibers,
which are free of contraction knots. Descriptions of myofascial pain date back to the mid-19th century, when Froriep described muskelschwiele,
or muscle calluses. He characterized these calluses as tender areas in
muscle that felt like a cord or band associated with rheumatic
complaints. In the early 1900s, Gowers first used the term fibrositis to
describe muscular rheumatism associated with local tenderness and
regions of palpable hardness.
In 1938, Kellgren described areas of referred pain associated with tender points in muscle. In the 1940s, Janet Travell, MD, began writing about myofascial trigger points. Her text, written in conjunction with David Simons, MD, continues to be viewed as the foundational literature on the subject of myofascial pain.[2]
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.[3] Temporomandibular joint (TMJ) syndrome also may be myofascial in origin. (See Prognosis, Presentation, Treatment, and Medication.)
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 (see the image below). (See Etiology, Presentation, and Treatment.)
Schematic
of a trigger point complex of a muscle in longitudinal section. A: The
central trigger point (CTrP) in the endplate zone contains numerous
electrically active loci and numerous contraction knots. A taut band of
muscle fibers extends from the trigger point to the attachment at each
end of the involved fibers. The sustained tension that the taut band
exerts on the attachment tissues can induce a localized enthesopathy
that is identified as an attachment trigger point (ATrP). B: Enlarged
view of part of the CTrP shows the distribution of 5 contraction knots.
The vertical lines in each muscle fiber identify the relative spacing of
its striations. The space between 2 striations corresponds to the
length of 1 sarcomere. The sarcomeres within one of these enlarged
segments (ie, contraction knot) of a muscle fiber are markedly shorter
and wider than the sarcomeres in the neighboring normal muscle fibers,
which are free of contraction knots. Descriptions of myofascial pain date back to the mid-19th century, when Froriep described muskelschwiele,
or muscle calluses. He characterized these calluses as tender areas in
muscle that felt like a cord or band associated with rheumatic
complaints. In the early 1900s, Gowers first used the term fibrositis to
describe muscular rheumatism associated with local tenderness and
regions of palpable hardness. In 1938, Kellgren described areas of referred pain associated with tender points in muscle. In the 1940s, Janet Travell, MD, began writing about myofascial trigger points. Her text, written in conjunction with David Simons, MD, continues to be viewed as the foundational literature on the subject of myofascial pain.[2]
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.[3] Temporomandibular joint (TMJ) syndrome also may be myofascial in origin. (See Prognosis, Presentation, Treatment, and Medication.)
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