12 - Trigger Points & Prolotherapy (Sandhouse) Flashcards

1
Q

TQ- What is a point in a taut band or muscle that when palpated gives you a very specific referred pain pattern and can give rise to autonomic phenomenon?

A

a Trigger Point (TrP)

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2
Q

What is the difference between active and latent trigger point?

A

Active TrP = pain without palpation

Latent TrP = pain only with palpation

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3
Q

A trigger point located in zone of referred pain of another trigger point is called what?

A

A satellite trigger point

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4
Q

A 24 yo pt comes in with local tenderness on their butt. With palpation, you feel a small nodular band of taut tissue. The patient jumps and the muscle twitches when you palate it. She also complains of pain to a specific zone. what is the possible diagnosis?

A

Trigger point!

Not fibromyalgia, because they won’t have the twitch

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5
Q

What is not a cause of Trigger points?

a) acute tissue injury
b) emotional or physical stress
c) repetitive motion
d) activation by another TrP
e) a Jones tenderpoint
f) chronic tissue injury

A

f) chronic tissue injury

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6
Q

You are NOT RESPONSIBLE for specific zones of referred pain for this lecture.

A

Wahoo!

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7
Q

[TQ?] A 58 yo patient comes in with palpitations and anxiety. You suspect a SVT. Treatment of what Trigger Point could possibly treat cardiac arrhythmia?

A

Right Pectoralis major trigger point

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8
Q

T or F: The Quadratus lumborum TrP is a great example of a satellite or associated TrP?

A

True!

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9
Q

Know the differences between TP, TrPs, and Chapman points! This seems important.

A

It’s all on a table.

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10
Q

A 24 yo pt comes in with local tenderness on their butt. With palpation, you feel a small nodular band of taut tissue. The patient jumps and the muscle twitches when you palate it. She also complains of pain to a specific zone. You suspect a Trigger Point. Which is not possible cause?

a) anemia
b) nutritional deficiencies
c) Hypothyroidism
d) Somatic dysfunction
e) acute infections
f) short leg syndrome

A

e) acute infections

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11
Q

A 24 yo pt comes in with local tenderness on their butt. With palpation, you feel a small nodular band of taut tissue. The patient jumps and the muscle twitches when you palate it. She also complains of pain to a specific zone. You suspect Trigger Points isolated to paraspinals, SCM and quadratus lumborum. Which is the possible cause?

a) anemia
b) nutritional deficiencies
c) Hypothyroidism
d) Somatic dysfunction
e) acute infections
f) short leg syndrome

A

f) short leg syndrome

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12
Q

A 24 yo pt comes in with local weakness of their arm with numbness and tingling. You suspect thoracic outlet syndrome. Which TrP is the possible cause?

a) anterior scalene
b) posterior scalene
c) middle scalene
d) Sternocleidomastoid muscle

A

a) anterior scalene

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13
Q

What are two possible treatments for Trigger Points?

a) spray with vapocoolant spray with stretch / trigger point injection with local anesthetics
b) spray with vapocoolant spray with stretch / trigger point injection with nothing
c) keep warm with heating pad with stretch / trigger point injection with local anesthetics
d) keep warm with heating pad with stretch / trigger point injection with steroids
e) spray with vapocoolant spray with stretch / topical steroid application
f) A and B

A

f) A and B

A) spray with vapocoolant spray with stretch / trigger point injection with local anesthetics
B) spray with vapocoolant spray with stretch / trigger point injection with nothing

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14
Q

Why does the Spray and stretch method works as a Trigger Point treatment?

A

The cold spray acts as a neurologic distraction (nociceptive inhibition) and the stretch breaks the “vicious cycle” via stimulation of Kraus receptors.

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15
Q

Which is not key in successful treatment of trigger points?

a) treating primary TrP
b) treat associated and satellite TrPs
c) treat any underlying or perpetuating factors
d) rest and relaxation

A

d) rest and relaxation

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16
Q

How is prolotherapy different than trigger point therapy?

A

Prolotherapy is the injection of solution to promote TISSUE HEALING and REGNERATION

17
Q

TQ What is the most common site of injection for prolotherapy?

a) attachment of tendon to ligament
b) attachment of ligament to fascia
c) attachment of fascia to tendon
d) attachment of tendon, ligament, or fascia to bone

A

d) attachment of tendon, ligament, or fascia to bone (AKA fibrooseous junction)

18
Q

I am a beginner and I need to try prolotherapy. What solution should I use?

A

12.5% Dextrose is recommended for beginners. (a mixture of Dextrose with xylocaine)

19
Q

Who do I love?

A

WILLLLIAMMMMMMMM!!!

20
Q

Which is a possible mechanism of action for prolotherapy?

a) needle causing cellular damage and stimulating inflammatory cascade
b) compression of cells by the extracellular volume of injected solution - stimulating intracellular growth factors
c) chemomodulation collagen through inflammatory proliferative, regenerative/reparative response mediated by cytokines and multiple growth factors.
d) all of the above

A

d) all of the above

21
Q

Which of the following phases of prolotherapy is correctly paired with their description?

a) inflammation - leads to tissue regeneration and repair
b) inflammation - increased tensilse strength, mass and load bearing capacity of collagenous connective tissue
c) remodeling - caused by repetitive stimulation of inflammation by injection of substance
d) Inflammation - caused by repetitive stimulation of inflammation by injection of substance

A

d) Inflammation - caused by repetitive stimulation of inflammation by injection of substance

22
Q

What is prolotherapy not useful for?

a) recurrent painful reib subluxations
b) vertebral compression factures with wedge deformity
c) post surgical thoracic and low back pain
d) iliac crest syndromes
e) painful enthesopathies tendinsosis or ligamentosis from overuse
f) painful enthesopathies tendinitis from overuse

A

f) painful enthesopathies tendinitis from overuse

??

23
Q

A rotator cuff tear, which is treatable and ammenable to prolotherapy, what diagnostic aid would be most appropriate?

a) CT scan
b) MRI
c) radiograph
d) none of the above
c) all of the above

A

b) MRI

can give some indication of enthesopathy or partial tear

24
Q

27 yo hockey player demonstrated a “complete” tear of the ACL. MRI demonstrated a “complete tear” of the ACL. Patient was treated with prolotherapy injections to the inferior attachment of the ACL. Repeat MRI 5 months later reported as a “partial” tear. What does this mean?

A

PROLOTHERAPY WORKS.

25
Q

TQ- What is a characteristic of a Travell Trigger Point?

A

Specific Zone of Referred Pain

26
Q

TQ- What is true regarding treatment of trigger points?

A

Inhibition of afferent impulses during Spray and Stretch occurs at the level of the spinal cord.