0413111100 - Opp Iv - Myofascial Trigger Points (Miller)

Front 1

WTF is a myofascial trigger point?

Back 1

small, circumscribed, consistent painful response when stimulated, tense band of muscle fibers (rope). recognizable painful pattern that is duplicated. indicates chronic, local muscle injury. can often respond by twitching.

"Trigger points or trigger sites are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers." -Wiki

Front 2

Why is it important to know your patients well when dealing with myofascial trigger points?

Back 2

most are exacerbated my ADLs, and so modification of ADLs may be necessary to full resolve the problem and the pt must trust you with these changes.

Front 3

What is a Jones (counterstrain) tenderpoint?

Back 3

small tense edematous area of tenderness the size of a fingertip. they do not radiate pain, but rather indicates a somatic dz at a mapped location.

Front 4

What's a very concise difference between a Chapman point, a tenderpoint, and a trigger point?

Back 4

Chapman - associated with visceral dz
trigger - taut band of ropey muscle all the time causing referred pain
tender - can be tender or not with no referred pain and associated with a specific somatic dz

Front 5

What two physicians developed trigger point theory?

Back 5

Dr. David Simons, MD
Dr. Janet Travell, MD

Front 6

What is the physiological cause of trigger point pathology?

Back 6

local over stimulation in an ATP depleted state. pain is associated with local nociceptive and autonomic nerves near small vessels in tissue.

with local ATP depletion, the muscle will use local anaerobic metabolism, so /\ pH and substance P => nociceptor sensitization => local and referred pain

Front 7

What is facilitation?

Back 7

pain generating nocirecptor pathways in spinal cord that can be activated by trigger point pathology and cause a lowered threshold for pain so that even the slightest touch is painful.

this produces a somatic change in the spine in a chronic, irreversible problem.

Front 8

What effect does acute pain have that chronic pain may not have?

Back 8

acute effects cognitive and motor behavior experience

Front 9

What is the board relevant 4 part criteria for dx'es of myofascial trigger points?

Back 9

1. taut palpable band
2. exquisite point tenderness of nodule within taut band
3. patient recognizes duplicable pain exacerbated by palpation
4. there is a painful limit to full stretch ROM

Front 10

How do you tx a trigger point?

Back 10

soft tissue inhibition, CS, FPR, ME, massage

Front 11

What is interesting about the referral pattern of an SCM trigger point?

Back 11

it looks like a migraine pattern, where the points along the sternal head are on the back of the head, around the eye, on the very top of the head, and on the lateral cheek

on the clavicular head the referred pain moves to very localized points right after the eye, and right behind the ear and somewhat in the ear.

Front 12

What is the referral pattern associated with a masseter trigger point?

Back 12

pain to lower jaw, teeth, gums, maxilla

tooth aches and tinnitus are not uncommon

Front 13

What's the referral pattern associated with a trapezius trigger point?

Back 13

Front 14

What is significant about the referral pattern for the scalenes

Back 14

it mimics a cervical radiculopathy

Front 15

What is the Psoas referral pattern?

Back 15