Because myofascial pain syndrome is such a common condition
that presents [in your office?],
let's talk about some of these muscles that become myofibrotic.
A very common muscle in myofascial pain syndromes is the upper trapezius.
The upper trapezius, when it develops a trigger point, refers pain into the lateral shoulder
close to your lateral neck,
behind the ear and the temporal region.
The trapezius muscle
may cause muscle tension headaches
and temporal headaches.
A patient that presents with headaches in the occipital region or temporal region
should be evaluated for a trigger point in the upper trapezius muscle.
The next muscle that’s quite common that develops trigger points
is the levator scapulae muscle.
The levator scapulae refers pain, as we talked earlier, into the posterolateral area of the neck,
into the lateral shoulder
and between the shoulder blades.
And often, the patient will say that they have tingling in this area.
In myofascial pain syndromes, this tingling is referred to as formication.
Another common muscle is one of the rotator cuff muscles, which is the supraspinatus.
That’s palpated by going just above the spine of the scapula,
and evaluating across the muscle
for a trigger point.
A trigger point in the supraspinatus will refer pain to the lateral shoulder.
Below the spine of the scapula is the infraspinatus.
There are generally two areas of trigger points in the infraspinatus.
The first one is along the border of the scapula
and the second one is in the belly of the muscle.
When palpated,
a trigger point will refer pain from the infraspinatus into the radial distribution of the arm,
and sometimes into the medial distribution of the hand, and may mimic a carpal tunnel syndrome.
The way you identify this trigger point is by palpating the taut band,
applying deep pressure,
and asking the patient if they feel it.
And if so, where?
Never ask them if they feel in the arm
because sometimes patients will want to make you happy and tell you exactly
what they think you want to hear.
The next muscle we want to evaluate is the rhomboid muscles,
which go between the scapula and the spine.
There are two rhomboid muscles,
the minor and the major.
You will palpate the belly of the muscle, looking for, like we said, a taut band
and a twitch response when you go over the muscle and this pain pattern will be
between the scapula and the spine.
Those are common upper trunk
and shoulder muscles which develop myofascial pain syndrome
and are very common after motor vehicle accidents or trauma.
Now let's evaluate the anterior shoulder musculature.
Would you turn and face me please, Deb?
The pectoralis minor muscle
is a muscle in the chest.
And it is palpated
in this region of the anterior shoulder.
And upon deep palpation over a trigger point of the pectoralis minor muscle,
you will get radiating or referred pain into the ulnar distribution of the hand,
and can mimic a C8 or T1 radiculopathy
or possibly, a lower trunk neurogenic thoracic outlet syndrome.
Now let's go to the muscles of the trunk and lower extremities.
In evaluating the lumbar muscles and muscles of the lower extremities,
I have to ask Deb to lie down.
The first muscle I’d like to evaluate is the quadratus lumborum.
And this muscle is evaluated by bringing the hand from the side of the thumb into the muscle
and looking for a taut band or trigger point.
And this muscle refers pain into the buttock
and into the low back area,
and can mimic a facet syndrome or an SI joint dysfunction problem.
Then there are gluteal muscles in the buttock,
which we look for gluteaus medius and minimus
to see if there are trigger points which will refer pain into the lower leg.
And finally, the piriformis muscle, which is in the belly of the buttock,
looking for a trigger point.
And upon deep palpation, that will refer pain into the lower extremity.
And that will mimic an S1 radiculopathy or possibly, a sacroiliac joint dysfunction.