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New Views of Myofascial Trigger Points: Etiology and Diagnosis

      Abstract

      Simons DG. New views of myofascial trigger points: etiology and diagnosis.
      Two studies appearing in Archives, one by Shah and colleagues and another one by Chen and colleagues, present groundbreaking findings that can reduce some of the controversy surrounding myofascial trigger points (MTPs). Both author groups recognize the ubiquity of this disease and the importance to patients of health care professionals becoming better acquainted with the cause and identification of MTPs. The integrated hypothesis is the most credible and most complete proposed etiology of MTPs. However, the feedback loop suggested in this hypothesis has a few weak links, and studies by Shah and colleagues in particular supply a solid link for one of them. The feedback loop connects the hypothesized energy crisis with the milieu changes responsible for noxious stimulation of local nociceptors that causes the local and referred pain of MTPs. Shah’s reports quantify the presence of not just 1 noxious stimulant but 11 of them with outstanding concentrations of immune system histochemicals. The results also strongly place a solid histochemical base under the important clinical distinction between active and latent MTPs. The study by Chen on the use of magnetic resonance elastography (MRE) imaging of the taut band of an MTP in an upper trapezius muscle may open a whole new chapter in the centuries-old search for a convincing demonstration of the cause of MTP symptoms. MRE is a modification of existing magnetic resonance imaging equipment, and it images stress produced by adjacent tissues with different degrees of tension. This report seems to present an MRE image of the taut band that shows the chevron signature of the increased tension of the taut band compared with surrounding tissues.

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      References

        • Shah J.P.
        • Phillips T.M.
        • Danoff J.V.
        • Gerber L.H.
        An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle.
        J Appl Physiol. 2005; 99: 1977-1984
        • Simons D.G.
        Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction.
        J Electromyogr Kinesiol. 2004; 14: 95-107
        • Shah J.P.
        • Danoff J.V.
        • Desai M.J.
        • et al.
        Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.
        Arch Phys Med Rehabil. 2008; 89: 16-23
        • Chen Q.
        • Bensamoun S.
        • Basford J.R.
        • Thompson J.M.
        • An K.N.
        Identification and quantification of myofascial taut bands with magnetic resonance elastography.
        Arch Phys Med Rehabil. 2007; 88: 1658-1661
        • Simons D.G.
        • Travell J.G.
        • Simons L.S.
        Travell & Simons’ myofascial pain and dysfunction: the trigger point manual. Vol 1.
        2nd ed. Williams & Wilkins, Baltimore1999
        • Mense S.
        • Simons D.G.
        • Russell I.J.
        Muscle pain: understanding its nature, diagnosis, and treatment.
        Lippincott Williams & Wilkins, Baltimore2001
        • Lucas K.R.
        • Polus P.A.
        • Rich J.
        Latent myofascial trigger points: their effect on muscle activation and movement efficiency.
        Bodywork Mov Ther. 2004; 8: 160-166
        • Ito Y.
        • Miledi R.
        • Vincent A.
        Transmitter release induced by a ‘factor’ in rabbit serum.
        Proc R Soc Lond B Biol Sci. 1974; 187: 235-241
        • Hong C.Z.
        Myofascial trigger point pathophysiology and correlation with acupuncture points.
        Acupunct Med. 2000; 18: 41-49
        • Brückle W.
        • Suckfüll M.
        • Fleckenstein W.
        • Weiss C.
        • Müller W.
        [Tissue pO2 measurement in taut back musculature (m. erector spinae)].
        Z Rheumatol. 1990; 49 ([German]): 208-216
        • Fassbender H.G.
        Non-articular rheumatism.
        in: Fassbender H.G. Pathology of rheumatic diseases. Springer-Verlag, Trans Loewi G. New York1975 (ch 13)
        • Tough E.A.
        • White A.R.
        • Richards S.
        • Campbell J.
        Variability of criteria used to diagnose myofascial trigger point pain syndrome—evidence from a review of the literature.
        Clin J Pain. 2007; 23: 278-286
        • Simons D.G.
        • Mense S.
        Understanding and measurement of muscle tone related to clinical muscle pain.
        Pain. 1998; 75: 1-17

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