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Trigger Point

See Also
1. Myofascial Pain Syndrome
2. Trigger Point Locations
Pathophysiology
1. Trigger points are central to Myofascial Pain Syndrome
2. Trigger Points result in generalized muscle changes
  1. Muscle shortening
  2. Muscle Weakness
  3. Decreased muscle range of motion
Preparation for exam
1. Patient examined in relaxed position
Signs
1. See Trigger Point Locations
2. Taut, ropy bands, knots or Nodules of muscle fibers
  1. Surrounded by normal feeling muscle
3. Muscle tenderness to palpation
  1. Local twitch response to palpation ("jump sign")
  2. Involuntary shortening of fibrous muscle band
4. Trigger points occur in predictable locations
  1. Trigger points occur longitudinally along muscle axis
  2. Trigger points are consistent from patient to patient
  3. Axial muscles (posture) most commonly affected
5. Pain Radiation
  1. Dull, aching, deep pain on trigger point palpation
  2. Predictable referred pain to distal reference zones
6. Functional Disability
  1. Decreased range of motion
  2. Decreased flexibility on active and passive stretch
  3. Weakness of affected muscle
7. Trigger point pain types
  1. Active Trigger Point
    1. Ongoing, persistent pain
    2. May activate satellite or secondary trigger points
  2. Latent Trigger Point
    1. Asymptomatic until palpated
Differential Diagnosis: Tender Point (Fibromyalgia)
1. Specific, symmetrical localized points in Fibromyalgia
2. Tender Points are associated with total body pain
3. Tender Points not associated with referred pain
Management
1. See Myofascial Pain Syndrome
2. See Trigger Point Injection
3. See Stretch and Spray
4. See Chronic Pain Management
Resources
1. Trigger Point Physiology from Myopoint
  1. http://myopoint.com/network/physicians/myalgia.htm
References
1. Alvarez (2002) Am Fam Physician 65(4):653
2. Fomby (1997) Phys Sportsmed 25(2):67

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.