Muscle disorders/tx Flashcards
Characterized by the presence of Trigger Points (TPs) in any voluntary
muscle which cause referred pain and referred tenderness and may
be active or latent. (3)
TPs evoke referred pain which usually originates from a distant site
rather than the site of the pain complaint.
ACTIVE TPs: are painful to palpation or spontaneously produce local
pain OR refer pain and autonomic symptoms (i.e. erythema) to
remote areas in reproducible patterns characteristic of each muscle.
LATENT TPs: exhibit local tenderness but do not currently cause
spontaneous clinical pain or symptoms. (1)
Myofascial pain syndrome
___ trigger point: are painful to palpation or spontaneously produce local
pain OR refer pain and autonomic symptoms (i.e. erythema) to
remote areas in reproducible patterns characteristic of each muscle.
ACTIVE TPs:
___ trigger point:exhibit local tenderness but do not currently cause
spontaneous clinical pain or symptoms.
LATENT TPs
An irritable locus within a taut band of skeletal muscle or fascia which when stimulated
elicits referred pain & tenderness (“secondary hyperalgesia- increased sensitivity to
normally painful stimuli outside & surrounding a zone of primary hyperalgesia”). (1)
Referred pain from myofascial trigger points is dull and aching, usually deep, and can range
from discomfort to incapacitating pain
Myofascial trigger point
increased sensitivity to
normally painful stimuli outside & surrounding a zone of primary hyperalgesia
secondary hyperalgesia-
“stimulation of specialized nerve endings designed to transmit
information to the central nervous system concerning potential or actual tissue
damage
Nociception:
“a specialized nerve ending that senses painful or harmful sensations”
Nociceptor:
described a means where the CNS may switch
on Nociception by stimulating the “on” cells which causes activation of the Trigeminal
Nucleus nociceptors.
Is chronic, continuous muscle pain (myalgia) that is aggravated by function and refers
pain beyond the boundary of the masticatory muscle being palpated
Central mediated pain
The most elusive and difficult to diagnose since it refers
pain to other locations in the mouth and in the face and
head & does Not always follow Cranial Nerve Distributions-
(CN XI with active SCM trigger point refers to CN V in face
and head)
Myofascial pain
Diagnostic Criteria: (must be present)
Regional dull, aching pain aggravated by mandibular function when muscles
of mastication are involved.
Trigger points have a characteristic pattern of pain referral & alters the pain
complaint on palpation or spontaneously.
> 50% pain reduction occurs with vapocoolant spray or local anesthetic
injection (trigger point injection) using 1% Procaine without vasoconstrictor.
Myofascial pain
increased response to a stimulus that is normally painful
hyperalgesia
TMJ and ear pain are referred to by what 4 muscles?
MASSETER (deep)
LATERAL PTERYGOID
MEDIAL PTERYGOID
STERNOCLEIDOMASTOID (clavicular)
Toothache:
Referred by: what 3 muscles?
TEMPORALIS
MASSETER (superficial)
DIGASTRIC (anterior)
Diagnostic Criteria: (must be present)
1. Muscle pain reported by patient in the jaw, temple, ear or pre-auricular area in the last 30 days
2. Pain is aggravated by jaw movement or parafunction (i.e. bruxism)
3. Muscle palpation exam causes report of localized muscle pain at palpation site
May be present:
1. Limited range of mouth opening MAY be present
Secondary to:
Ischemia
Bruxism
Fatigue
Metabolic alterations
Delayed onset muscle soreness from overuse
Protective splinting
Myalgia
Diagnostic Criteria must be present: (5)
1. Local muscle pain following injury (non-infective) or infection (infective)
2. Edema, erythema, &/or increased temperature over the muscle
May be present:
1. Serologic tests may reveal elevated enzyme levels (i.e. creatine kinase), markers
of inflammation & the presence of an autoimmune disease.
2. Diffuse tenderness over the entire muscle.
3. Increased pain with jaw use if masticatory muscles involved.
4. Limited range of motion of unassisted mandibular movements secondary to pain.
myositis
