Anatomical Basis of the Myofascial Trigger Points of the Gluteus Maximus Muscle

Abstract

Myofascial pain syndrome is characterized by pain and limited range of motion in joints and caused by muscular contracture related to dysfunctional motor end plates and myofascial trigger points (MTrPs). We aimed to observe the anatomical correlation between the clinically described MTrPs and the entry point of the branches of the inferior gluteal nerve into the gluteus maximus muscle. We dissected twenty gluteus maximus muscles from 10 human adult cadavers (5 males and 5 females). We measured the muscles and compiled the distribution of the nerve branches into each of the quadrants of the muscle. Statistical analysis was performed by using Student's t-test and Kruskal-Wallis tests. Although no difference was observed either for muscle measurements or for distribution of nerve branching among the subjects, the topography of MTrPs matched the anatomical location of the entry points into the muscle. Thus, anatomical substract of the MTrPs may be useful for a better understanding of the physiopathology of these disorders and provide basis for their surgical and clinical treatment.

An Anatomical Basis for the Myofascial Trigger Points of the Abductor Hallucis Muscle

“…e relationship between the entry points of nerves into the muscle belly and the myofascial trigger points has already been reported by Akamatsu et al [25,26]. Nerves are responsible for muscle contraction through the release of acetylcholine from the motor endplate.…”

“…All entry points of the branches of the medial plantar nerve on the lateral side of the muscle and the medial face of the muscle were demarcated with pins. e boundaries of the quadrants [26,27] were traced with surgical wires, and the anatomical references were as follows: the X axis (anteroposterior) began at the origin (medial tuberosity of the calcaneus) and ended at the insertion (base of the first proximal phalanx), and the Y axis (transversal) originated from the midpoint of the X axis, close to the navicular bone ( Figure 2). e number of entry points of each of the branches of the medial plantar nerve into the muscle in each quadrant was demarcated, and the statistical analysis was performed by a blind evaluator to avoid the observer bias.…”

“…Another important finding described in a recent study demonstrated that there may be a relationship between the entry points of the nerves to the muscle belly and the myofascial trigger points [25,26]. A detailed description of the anatomy remains one of the best ways to better understand the pathophysiology and clinical applicability of myofascial trigger points.…”

myoActivation: A Structured Process for Chronic Pain Resolution

“…Myofascial pain syndrome is characterized by multisite pain, referred pain, coupled pain, and peripheral and central sensitisations. A component of myofascial pain is due to MTPs associated with muscles in sustained contraction causing limitation of movement across joints [37]. The mechanisms of myofascial pain have been reviewed by Jafri [31] and Shah et al [48].…”

“…MTPs can generate continual nociceptive traffic to induce central sensitization, cortical re-organization, and alterations in descending inhibitory pain pathways [32][33][34][35][36]. MTPs are associated with muscles in sustained contraction causing limited movement across joints [37]. The MSK system is symmetrical; a muscle in sustained contraction on one side will cause compensatory MSK issues to occur on the other.…”