II. Pathophysiology

  1. Trigger Points are central to Myofascial Pain Syndrome
  2. Trigger Points result in generalized muscle changes
    1. Tense skeletal muscle bands
    2. Muscle shortening
    3. Muscle Weakness
    4. Decreased muscle range of motion
  3. Trigger Point compression induces local and referred pain
    1. Compression of Trigger Point leads to local ischemia
    2. Ischemia leads to local inflammatory factor (prostaglandin, kinin) release

III. Preparation for exam

  1. Patient examined in relaxed position

IV. 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

V. 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

VII. Resources

  1. Trigger Point Physiology from Myopoint
    1. http://myopoint.com/network/physicians/myalgia.htm

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Ontology: Trigger point (C0458343)

Definition (MSHCZE) Určitá místa v těle, jejichž stimulace vyvolá vjemy nebo příznaky jinde v těle. R
Definition (MSH) Discrete spots in taut bands of muscle that produce local and referred pain when muscle bands are compressed.
Concepts Body Location or Region (T029)
MSH D061028
SnomedCT 183975007, 134190002
English points triggering, point trigger, points trigger, trigger point, Trigger Points, Point, Trigger, Trigger Point, Points, Trigger, TP - Trigger point, Trigger point (body structure), Trigger point
French Points détente, Points de déclenchement, Points gâchette
Portuguese Pontos-Gatilho, Pontos Gatilhos
Russian ТРИГГЕРНЫЕ ТОЧКИ, TRIGGERNYE TOCHKI, TRIGGERNYE OBLASTI, ТРИГГЕРНЫЕ ОБЛАСТИ
Spanish Puntos Disparadores, Puntos Desencadenantes, Puntos Gatillo, Puntos Gatillos, zona gatillo (estructura corporal), zona gatillo
Czech spouštěcí body, spoušťový bod
Polish Punkty spustowe
Italian Punti trigger
German Triggerpunkt, Triggerpunkte
Norwegian Triggerpunkter, Triggerpunkt