Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study

Abstract

Our aim was to describe the differences in the presence of trigger points (TrPs) in the shoulder muscles and to investigate the presence of mechanical hypersensitivity in patients with unilateral shoulder impingement and healthy controls. Twelve patients with strictly unilateral shoulder impingement and 10 matched controls were recruited. TrPs in the levator scapula, supraspinatus, infraspinatus, subscapularis, pectoralis major, and biceps brachii muscles were explored. TrPs were considered active if the local and referred pain reproduced the pain symptoms and the patient recognized the pain as a familiar pain. Pressure pain thresholds (PPT) were assessed over the levator scapulae, supraspinatus, infraspinatus, pectoralis major, biceps brachii, and tibialis anterior muscles. Both explorations were randomly done by an assessor blinded to the subjects' condition. Patients with shoulder impingement have a greater number of active (mean +/- SD: 2.5 +/- 1; P < 0.001) and latent (mean +/- SD: 2 +/- 1; P = 0.003) TrPs when compared to controls (only latent TrPs, mean +/- SD: 1 +/- 1). Active TrPs in the supraspinatus (67%), infraspinatus (42%), and subscapularis (42%) muscles were the most prevalent in the patient group. Patients showed a significant lower PPT in all muscles when compared to controls (P < 0.001). Within the patient group a significant positive correlation between the number of TrPs and pain intensity (r (s) = 0.578; P = 0.045) was found. Active TrPs in some muscles were associated to greater pain intensity and lower PPTs when compared to those with latent TrPs in the same muscles (P < 0.05). Significant negative correlations between pain intensity and PPT levels were found. Patients with shoulder impingement showed widespread pressure hypersensitivity and active TrPs in the shoulder muscles, which reproduce their clinical pain symptoms. Our results suggest both peripheral and central sensitisation mechanisms in patients with shoulder impingement syndrome.

Muscle Trigger Points, Pressure Pain Threshold, and Cervical Range of Motion in Patients With High Level of Disability Related to Acute Whiplash Injury

“…21 It has also been proposed that myofascial trigger points (TrPs) may be involved in sensitization processes of the central nervous system. 7 Some studies have demonstrated an association between TrPs and central sensitization mechanisms in different pain syndromes, such as chronic tension-type headache, 10 lateral epicondylalgia, 9 shoulder pain, 18 temporomandibular pain, 11 and fibromyalgia syndrome.…”

Effectiveness of Myofascial Release Therapy with Shoulder Taping on Subacromial Impingement Syndrome in Collegiate Basket Ball Players -A Quasi experimental Pilot study

“…However, because these studies focus much on MTrPs, there is no direct evidence that these interventions did have or did not have an effect on MTrPs. 31 Taping helps in pain reduction by modulation of the pain fibers and altering the sensory input and facilitation or inhibition of the muscle activity 20 . Taping help to stimulate the neuromuscular pathway via increased afferent feedback from cutaneous receptors and can facilitate neuromuscular response 21,22 .…”

Utility of Craniosacral Therapy in Treatment of Patients with Non-specific Low Back Pain. Preliminary Report.

“…Tense muscle bands in overload muscles are relaxed by manual stretching or ischa emic pressure [19][20][21][22][23][24]. Additionally many studies have proved the effectiveness of this method in chronic, overload-and tension-related musculoskeletal pain [20,[25][26][27][28]. However, a query of such bibliogra -tej me to dy w prze wle kłych, prze cią że nio wych oraz na pię cio wych do le gli wo ściach bó lo wych apa ra tu ruchu [20,[25][26][27][28].…”

“…Additionally many studies have proved the effectiveness of this method in chronic, overload-and tension-related musculoskeletal pain [20,[25][26][27][28]. However, a query of such bibliogra -tej me to dy w prze wle kłych, prze cią że nio wych oraz na pię cio wych do le gli wo ściach bó lo wych apa ra tu ruchu [20,[25][26][27][28]. Pod czas ana li zy do stęp nych baz biblio gra ficz nych ta kich jak: Pub Med/Me dli ne, Scopus, Co chra ne, Pe dro nie na tra fio no na to miast na arty ku ły na uko we ba da ją ce za sto so wa nie TCK w przecią że nio wych ze spo łach bó lo wych dol ne go od cin ka krę go słu pa. Nie licz ne ba da nia wska zu ją za sto so wanie TCK w ni we lo wa niu na pię cio wych i mi gre nowych bó lów gło wy, a ta kże w le cze niu kol ki po karmo wej u nie mow ląt [29][30][31].…”