4module 4.4 examination slides
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8/11/2019 4Module 4.4 Examination Slides
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5/12/14
1
!"#$%&#'%(&
Myofascial Pain
Bernadette Jaeger DDS
Adjunct ProfessorSchools of Medicine and DentistryUniversity of California, Los Angeles
!"#$#%&" ()&*+,)- ./
01./&-%#&" 2,#33), 4.#$* 4&#$
1. Localized, tender “spot” or nodule
2. in a taut band of skeletal muscle
3. with a local twitch response (LTR)
4. and associated referred pain.
5. Clinically, reproduction of usual pain.
8/11/2019 4Module 4.4 Examination Slides
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!"#$#%&" ()&*+,)- ./
01./&-%#&" 2,#33), 4.#$* 4&#$1.Localized , tender spot
or nodule
2. in a taut band of skeletal muscle
3. with a local twitch response (LTR)
4. and associated referred pain.
5. Clinically, reproduction of usual pain.
8/11/2019 4Module 4.4 Examination Slides
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5/12/14
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56.$*&$).+- 7")%*,#%&" 8%9:#*1 ;578<
#$ 0(2,4-
!"#$#%&" ()&*+,)- ./
01./&-%#&" 2,#33), 4.#$* 4&#$
1. Localized, tender “spot” or nodule
2. in a taut band of skeletal muscle
3. with a local twitch response (LTR)
4. and associated referred pain.
5. Clinically, reproduction of usual pain.
8/11/2019 4Module 4.4 Examination Slides
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5/12/14
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=)"#&>#"#*1 ./ *?) 4,)--+,) 8"3.@)*), &- &
0)&-+,) ./ 2,#33), 4.#$* 5)$-#9:#*1Reeves JL, Jaeger B, Graff-Radford SB Pain (24) 313-324; 1986
4,)--+,) 2?,)-?."A /., =)/),,)A 4&#$ >1
!.@6,)--#.$ .$ *?) 2,#33), 4.#$* &$A
8AB&%)$* 8,)&-Hong et al: J Musculoskeletal Pain 4(3)61-79, 1996
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5)$-#9:#*1 5%.,)-CCC /., 2,#33), 4.#$*- &$A
8AB&%)$* D.$E2,#33), 4.#$* 0+-%+"&, 8,)&-
Measurement Location TrP Non-TrP
Superficial Masseter* 2.73 3.13
Anterior Temporalis** 2.87 3.57
Splenius Capitis* 2.66 3.51
Trapezius** 3.69 4.65
Semispinalis Capitis* 3.63 4.07
* p < .05** p < 0.01
*** Sensitivity measured in kg/cm2
!"#$#%&" ()&*+,)- ./
01./&-%#&" 2,#33), 4.#$* 4&#$
1. Localized, tender “spot” or nodule
2. in a taut band of skeletal muscle
3. with a local twitch response (LTR)
4. and associated referred pain.
5. Clinically, reproduction of usual pain.
8/11/2019 4Module 4.4 Examination Slides
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5/12/14
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2&+* F&$A- •
Easily palpated
•
Common in normal control subjects•
Rabbit model exists
•
Depend on an intact nerve supply
• Contain the trigger point
Relaxedmuscle fibers
Taut band
!"#$#%&" ()&*+,)- ./
01./&-%#&" 2,#33), 4.#$* 4&#$
1. Localized, tender “spot” or nodule
2. in a taut band of skeletal muscle
3. with a local twitch response (LTR)
4. and associated referred pain.
5. Clinically, reproduction of usual pain.
8/11/2019 4Module 4.4 Examination Slides
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5/12/14
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5)*+6 /., ):&"+&9.$ ./ G2=
Responsive Band
Hong C-Z, Torigoe Y, 1994
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G.%&" 2H#*%? =)-6.$-)
•
Demonstrated by EMG
•
Rabbit model exists
•
Localized to the taut
band
•
Best elicited at the TrP
•
Spinal cord reflex
!"#$#%&" ()&*+,)- ./
01./&-%#&" 2,#33), 4.#$* 4&#$
1. Localized, tender “spot” or nodule
2. in a taut band of skeletal muscle
3. with a local twitch response (LTR)
4. and associated referred pain.
5. Clinically, reproduction of usual pain.
8/11/2019 4Module 4.4 Examination Slides
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5/12/14
9
!"#$#%&" ()&*+,)- ./
01./&-%#&" 2,#33), 4.#$* 4&#$
1. Localized, tender “spot” or nodule
2. in a taut band of skeletal muscle
3. with a local twitch response (LTR)
4. and associated referred pain.
5. Clinically, reproduction of usual pain.
8/11/2019 4Module 4.4 Examination Slides
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5/12/14
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8/11/2019 4Module 4.4 Examination Slides
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4,)--+,) 2?,)-?."A /., =)/),,)A 4&#$ >1
!.@6,)--#.$ .$ *?) 2,#33), 4.#$* &$A8AB&%)$* 8,)&-Hong et al: J Musculoskeletal Pain 4(3)61-79, 1996
2,#33), 4.#$* 7I&@#$&9.$Based on the algometry data, palpation
requires up to 2-4 kilograms per square
centimeter of pressure to elicit pain response.
Up to 2-4 kg/cm2
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2,#33), 4.#$* 7I&@#$&9.$
Based on the documented delay in emergence
of the referred pain patterns, and Mense’s
theory of “unmasking latent connections” in the
spinal cord, palpation pressure should be held
for at least 10-15 seconds to allow the referral
pattern to develop.
10-15 seconds
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2)@6.,&"#- =)/),,&" 4&J),$
2,&6)K#+-
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01./&-%#&" 2,4 4&#$ #- !"#$!#%&!'
Recognition and appropriate
management are essential for
successful treatment outcomes.
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