Sanjeev Arora MD PDF
Preview Sanjeev Arora MD
MYOFASCIAL PAIN Focus on the Upper Extremity Benson Daitz MD & Brian M. Shelley MD UNM Family & Community Medicine Resident School, April 2018 FINANCIAL DISCLOSURES •None. OBJECTIVES: MPS After this session, participants will be able to: • Define myofascial pain syndrome (MPS) • Identify common presentations of MPS in the upper extremity • Perform a trigger point injection in a myofascial trigger point. MYOFASCIAL PAIN SYNDROME (MPS) • Characterized by the development of myofascial trigger points (TrP or MTrP) that are locally tender when active. • Refer pain through specific patterns to other areas of the body. • Due to many causes like trauma, arthritis, deconditioning. • Trigger points are usually associated with a taut band, a ropey thickening of the muscle tissue. • Diagnosis depends on history, exam, and specialized manual palpation. • Local twitch response may be seen in palpation and treatment • Fascia also very important. JANET TRAVELL MD •A TrP is a “hyperirritable spot, usually within a taut band of skeletal muscles or in the muscle’s fascia, that is painful on compression and that can give rise to characteristic phenomena.” MPS: Mechanism (Travell) • The “integrated hypothesis” includes: • Spine • Muscle • NMJ • Abnormalities at the neuro-muscular junction: ↑ ACh production, depolarization ↑ Sustained shortening of sarcomeres ↑ Energy demand, release of sensitizing substances, leading to… ↑ ACh production (BTXA blocks release) SHAH • Compared to carefully matched controls, people with neck pain secondary to active TrPs had significantly elevated local levels of • endogenous substance P (SP) • calcitonin gene-related peptide (CGRP) • bradykinin (BK) • serotonin/5-hydroxytryptamine (5-HT) • norepinephrine (NE) • tumor necrosis factor alpha (TNF-α) • interleukin 1-beta (IL-1β) Shah JP, Danoff JV, Desai M, 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. SHAH •At motor endplate (distal axon): •↑CGRP → ↑Ach → ↓AchE activity •Leads to increased ACh receptors and activity, and persistent focal muscle fiber contraction •TrPs have spontaneous electrical activity (SEA), or dysfunctional endplate potential of extrafusal (skeletal) muscle fibers
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