Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial

Carel Bron, Arthur de Gast, Jan Dommerholt, Boudewijn Stegenga, Michel Wensing, Rob A B Oostendorp, Carel Bron, Arthur de Gast, Jan Dommerholt, Boudewijn Stegenga, Michel Wensing, Rob A B Oostendorp

Abstract

Background: Shoulder pain is a common musculoskeletal problem that is often chronic or recurrent. Myofascial trigger points (MTrPs) cause shoulder pain and are prevalent in patients with shoulder pain. However, few studies have focused on MTrP therapy. The aim of this study was to assess the effectiveness of multimodal treatment of MTrPs in patients with chronic shoulder pain.

Methods: A single-assessor, blinded, randomized, controlled trial was conducted. The intervention group received comprehensive treatment once weekly consisting of manual compression of the MTrPs, manual stretching of the muscles and intermittent cold application with stretching. Patients were instructed to perform muscle-stretching and relaxation exercises at home and received ergonomic recommendations and advice to assume and maintain good posture. The control group remained on the waiting list for 3 months. The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score (primary outcome), Visual Analogue Scale for Pain (VAS-P), Global Perceived Effect (GPE) scale and the number of muscles with MTrPs were assessed at 6 and 12 weeks in the intervention group and compared with those of a control group.

Results: Compared with the control group, the intervention group showed significant improvement (P < 0.05) on the DASH after 12 weeks (mean difference, 7.7; 95% confidence interval (95% CI), 1.2 to 14.2), on the VAS-P1 for current pain (mean difference, 13.8; 95% CI, 2.6 to 25.0), on the VAS-P2 for pain in the past 7 days (mean difference, 10.2; 95% CI, 0.7 to 19.7) and VAS-P3 most severe pain in the past 7 days (mean difference, 13.8; 95% CI, 0.8 to 28.4). After 12 weeks, 55% of the patients in the intervention group reported improvement (from slightly improved to completely recovered) versus 14% in the control group. The mean number of muscles with active MTrPs decreased in the intervention group compared with the control group (mean difference, 2.7; 95% CI, 1.2 to 4.2).

Conclusions: The results of this study show that 12-week comprehensive treatment of MTrPs in shoulder muscles reduces the number of muscles with active MTrPs and is effective in reducing symptoms and improving shoulder function in patients with chronic shoulder pain.

Trial registration number: ISRCTN: ISRCTN75722066.

Figures

Figure 1
Figure 1
Referred pain pattern (red) from supraspinatus muscle MTrP
Figure 2
Figure 2
Referred pain pattern (red) from infraspinatus muscle MTrP
Figure 3
Figure 3
Referred pain pattern from teres minor muscle MTrP
Figure 4
Figure 4
Referred pain pattern from subscapularis muscle MTrP. The referred pain patterns according to Simons et al. [26]. MTrPs are indicated by X. Illustrations courtesy of LifeART/MEDICLIP [88].
Figure 5
Figure 5
Manual compression on the MTrP in the infraspinatus muscle of the left shoulder.
Figure 6
Figure 6
Stroking with ice (in a polystyrene cup) in unidirectional parallel strokes combined with gentle muscle stretching applied for the infraspinatus muscle of the left shoulder while the patient was lying on one side.
Figure 7
Figure 7
Cross-body muscle-stretching exercise for posterior shoulder muscles, including the infraspinatus muscle.
Figure 8
Figure 8
Schematic showing patient participation.
Figure 9
Figure 9
The mean Disability of Arm, Shoulder, and Hand outcome measure (DASH) scores (error bars represent 95% confidence intervals) at intake, after 6 weeks and after 12 weeks for the intervention group (n = 34) and the control group (n = 31).
Figure 10
Figure 10
The number of patients who improved by more than 10 points (minimal clinically important difference) on the DASH outcome measure after 12 weeks for the intervention group (n = 34) and the control group (n = 31).

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