Trigger points: an anatomical substratum

Flávia Emi Akamatsu, Bernardo Rodrigues Ayres, Samir Omar Saleh, Flávio Hojaij, Mauro Andrade, Wu Tu Hsing, Alfredo Luiz Jacomo, Flávia Emi Akamatsu, Bernardo Rodrigues Ayres, Samir Omar Saleh, Flávio Hojaij, Mauro Andrade, Wu Tu Hsing, Alfredo Luiz Jacomo

Abstract

This study aimed to bring the trapezius muscle knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTrPs). Although anatomoclinical correlations represent a major feature of MTrP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTrP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Seven points are described, four of which are motor points: in all cases, these locations corresponded to clinically described MTrPs. The four points were common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MTrP is useful to achieve a better understanding of the anatomical correlation of MTrP and the physiopathology of these disorders and may provide a scientific basis for their treatment, rendering useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches.

Figures

Figure 1
Figure 1
Scheme of anatomical location of MTrP1, MTrP2, MTrP3, MTrP3.1, MTrP4, MTrP5, MTrP5.1, MTrP5.2, and MTrP6. Motor endplate locations correspond to MTrP1, MTrP2, MTrP3, MTrP3.1, MTrP5, MTrP5.1, and MTrP5.2. MTrP4 and MTrP6 are insertional trigger points. Observe on the left side that points 5 and 3 are regions that correspond to nerve insertional points. The accessory nerve and its branches are highlighted in yellow.
Figure 2
Figure 2
Gross anatomy image corresponding to the previous scheme. Dissection of the trapezius muscle and the areas corresponding to the clinical trigger points. Reflection of the right trapezius muscle showing the entry points of the spinal accessory nerve branches that coincide with the MTrPs 1, 2, 3, 3.1, 5, 5.1, and 5.2. Trapezius muscle, levator scapulae, rhomboid major, and rhomboid minor are identified.

References

    1. Chen K.-H., Hong C.-Z., Kuo F.-C., Hsu H.-C., Hsieh Y.-L. Electrophysiologic effects of a therapeutic laser on myofascial trigger spots of rabbit skeletal muscles. American Journal of Physical Medicine & Rehabilitation. 2008;87(12):1006–1014. doi: 10.1097/phm.0b013e31817f9fee.
    1. Ge H.-Y., Fernández-de-las-Peñas C., Madeleine P., Arendt-Nielsen L. Topographical mapping and mechanical pain sensitivity of myofascial trigger points in the infraspinatus muscle. European Journal of Pain. 2008;12(7):859–865. doi: 10.1016/j.ejpain.2007.12.005.
    1. Hong C. Z. Myofascial trigger points: pathophysiology and correlation with acupuncture points. Acupuncture in Medicine. 2000;18(1):41–47. doi: 10.1136/aim.18.1.41.
    1. Huguenin L. K. Myofascial trigger points: the current evidence. Physical Therapy in Sport. 2004;5(1):2–12. doi: 10.1016/j.ptsp.2003.11.002.
    1. Simons D. G., Travell J. G., Simons L. S. Myofascial Pain and Dysfunction: The Trigger Point Manual. Vol. 1. Baltimore, Md, USA: Lippincott Williams & Wilkins; 2005.
    1. White K. P., Harth M. Classification, epidemiology, and natural history of fibromyalgia. Current Pain and Headache Reports. 2001;5(4):320–329. doi: 10.1007/s11916-001-0021-2.
    1. Ge H. Y., Nie H., Madeleine P., Danneskiold-Samsøe B., Graven-Nielsen T., Arendt-Nielsen L. Contribution of the local and referred pain from active myofascial trigger points in fibromyalgia syndrome. Pain. 2009;147(1–3):233–240. doi: 10.1016/j.pain.2009.09.019.
    1. Gran J. T. The epidemiology of chronic generalized musculoskeletal pain. Best Practice and Research: Clinical Rheumatology. 2003;17(4):547–561. doi: 10.1016/S1521-6942(03)00042-1.
    1. Fernández-de-las-Peñas C., Ge H.-Y., Alonso-Blanco C., González-Iglesias J., Arendt-Nielsen L. Referred pain areas of active myofascial trigger points in head, neck, and shoulder muscles, in chronic tension type headache. Journal of Bodywork and Movement Therapies. 2010;14(4):391–396. doi: 10.1016/j.jbmt.2009.06.008.
    1. Harden R. N., Bruehl S. P., Gass S., Niemiec C., Barbick B. Signs and symptoms of the myofascial pain syndrome: a national survey of pain management providers. The Clinical Journal of Pain. 2000;16(1):64–72. doi: 10.1097/00002508-200003000-00010.
    1. Chu J. Dry needling (intramuscular stimulation) in myofascial pain related to lumbosacral radiculopathy. European Journal of Physical Medicine and Rehabilitation. 1995;5(4):106–121.
    1. Lin T. Y., Teixeira M. J., Kaziyama H. H. S. Dor—Síndrome dolorosa miofascial e dor músculo-esquelética. 1st. São Paulo, Brazil: ROCA; 2008.
    1. Simons D. G., Travell J. G., Simons L. S. Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd. Baltimore, Md, USA: Lippincott Williams & Wilkins; 1999.
    1. Fumal A., Schoenen J. Tension-type headache: current research and clinical management. The Lancet Neurology. 2008;7(1):70–83. doi: 10.1016/s1474-4422(07)70325-3.
    1. Sciotti V. M., Mittak V. L., DiMarco L., et al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001;93(3):259–266. doi: 10.1016/S0304-3959(01)00325-6.
    1. Simons D. G. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. Journal of Electromyography and Kinesiology. 2004;14(1):95–107. doi: 10.1016/j.jelekin.2003.09.018.
    1. Lavelle E. D., Lavelle W., Smith H. S. Myofascial trigger points. Anesthesiology Clinics. 2007;25(4):841–851. doi: 10.1016/j.anclin.2007.07.003.
    1. Simons D. G., Hong C.-Z., Simons L. S. Endplate potentials are common to midfiber myofacial trigger points. The American Journal of Physical Medicine and Rehabilitation. 2002;81(3):212–222. doi: 10.1097/00002060-200203000-00010.
    1. Fernández-de-las-Peñas C., Gröbli C., Ortega-Santiago R., et al. Referred pain from myofascial trigger points in head, neck, shoulder, and arm muscles reproduces pain symptoms in blue-collar (manual) and white-collar (office) workers. Clinical Journal of Pain. 2012;28(6):511–518. doi: 10.1097/ajp.0b013e31823984e2.
    1. Simons D. G. Do endplate noise and spikes arise from normal motor endplates? The American Journal of Physical Medicine and Rehabilitation. 2001;80(2):134–140. doi: 10.1097/00002060-200102000-00012.
    1. Karakurum B., Karaalin O., Coskun Ö., Dora B., Üçler S., Inan L. E. The ‘dry-needle technique’: intramuscular stimulation in tension-type headache. Cephalalgia. 2001;21(8):813–817.
    1. Tollison C. D., Satterthwaite C. D., Tollison J., editors. Handbook of Pain Management. 2nd. Baltimore, Md, USA: Lippincott Williams & Wilkins; 2002.
    1. Hong C.-Z., Hsueh T.-C. Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Archives of Physical Medicine and Rehabilitation. 1996;77(11):1161–1166. doi: 10.1016/S0003-9993(96)90141-0.
    1. Basmajian J. V., de Luca C. J. Muscles Alive: Their Functions Revealed by Electromyography. 5th. Baltimore, Md, USA: Lippincott Williams & Wilkins; 1985.
    1. Hsueh T. C., Cheng P. T., Kuan T. S., Hong C. Z. The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points. American Journal of Physical Medicine and Rehabilitation. 1997;76(6):471–476. doi: 10.1097/00002060-199711000-00007.
    1. Olavi A., Pekka R., Pertti K., Pekka P. Effects of the infrared laser therapy at treated and non-treated trigger points. Acupuncture & Electro-Therapeutics Research. 1989;14:9–14.
    1. Moore K. L., Dalley A. F. Clinically Oriented Anatomy. 6th. Baltimore, Md, USA: Lippincott Williams & Wilkins; 2010.
    1. Stranding S. Gray's Anatomy. 40th. London, UK: Churchill Livingstone; 2008.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren