Myofascial Trigger Points of the Shoulder
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Chiropractic & Osteopathy
Chiropractic & Osteopathy BioMed Central Research Open Access Neuro Emotional Technique for the treatment of trigger point sensitivity in chronic neck pain sufferers: A controlled clinical trial Peter Bablis1, Henry Pollard*1,2 and Rod Bonello1 Address: 1Macquarie Injury Management Group, Macquarie University, Sydney, Australia and 2Director of Research, ONE Research Foundation, Encinitas, California, USA Email: Peter Bablis - [email protected]; Henry Pollard* - [email protected]; Rod Bonello - [email protected] * Corresponding author Published: 21 May 2008 Received: 12 May 2007 Accepted: 21 May 2008 Chiropractic & Osteopathy 2008, 16:4 doi:10.1186/1746-1340-16-4 This article is available from: http://www.chiroandosteo.com/content/16/1/4 © 2008 Bablis et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Trigger points have been shown to be active in many myofascial pain syndromes. Treatment of trigger point pain and dysfunction may be explained through the mechanisms of central and peripheral paradigms. This study aimed to investigate whether the mind/body treatment of Neuro Emotional Technique (NET) could significantly relieve pain sensitivity of trigger points presenting in a cohort of chronic neck pain sufferers. Methods: Sixty participants presenting to a private chiropractic clinic with chronic cervical pain as their primary complaint were sequentially allocated into treatment and control groups. Participants in the treatment group received a short course of Neuro Emotional Technique that consists of muscle testing, general semantics and Traditional Chinese Medicine. -
Effectiveness of Dry Needling for Myofascial Trigger Points Associated with Neck and Shoulder Pain: a Systematic Review and Meta-Analysis
Archives of Physical Medicine and Rehabilitation journal homepage: www.archives-pmr.org Archives of Physical Medicine and Rehabilitation 2015;96:944-55 REVIEW ARTICLE (META-ANALYSIS) Effectiveness of Dry Needling for Myofascial Trigger Points Associated With Neck and Shoulder Pain: A Systematic Review and Meta-Analysis Lin Liu, MSc,a Qiang-Min Huang, MD, PhD,a,b Qing-Guang Liu, MSc,a Gang Ye, MCh,c Cheng-Zhi Bo, BSc,a Meng-Jin Chen, BSc,a Ping Li, PTb From the aDepartment of Sport Medicine and the Center of Rehabilitation, School of Sport Science, Shanghai University of Sport, Shanghai; bDepartment of Pain Rehabilitation, Shanghai Hudong Zhonghua Shipbuilding Group Staff-worker Hospital, Shanghai; and cDepartment of Pain Rehabilitation, Tongji Hospital, Tongji University, Shanghai, China. Abstract Objective: To evaluate current evidence of the effectiveness of dry needling of myofascial trigger points (MTrPs) associated with neck and shoulder pain. Data Sources: PubMed, EBSCO, Physiotherapy Evidence Database, ScienceDirect, The Cochrane Library, ClinicalKey, Wanfang Data Chinese database, China Knowledge Resource Integrated Database, Chinese Chongqing VIP Information, and SpringerLink databases were searched from database inception to January 2014. Study Selection: Randomized controlled trials were performed to determine whether dry needling was used as the main treatment and whether pain intensity was included as an outcome. Participants were diagnosed with MTrPs associated with neck and shoulder pain. Data Extraction: Two reviewers independently screened the articles, scored methodological quality, and extracted data. The results of the study of pain intensity were extracted in the form of mean and SD data. Twenty randomized controlled trials involving 839 patients were identified for meta-analysis. -
Bilateral Sternalis Muscles Were Observed During Dissection of the Thoraco-Abdominal Region of a Male Cadaver
Case Reports Ahmed F. Ibrahim, MSc, MD, Saeed A. Makarem, MSc. PhD, Hassem H. Darwish, MBBCh. ABSTRACT Bilateral sternalis muscles were observed during dissection of the thoraco-abdominal region of a male cadaver. A full description of the muscles, as well as their attachments and innervations were reported. A brief review of the existing literature, regarding the nomenclature, incidence, attachments, innervations and clinical relevance of the sternalis muscle, is also presented. Neurosciences 2005; Vol. 10 (2): 171-173 he importance of continuing to record and Case Report. A well defined sternalis muscle Tdiscuss anatomical anomalies was addressed (Figures 1 & 2) was found, bilaterally, during recently1 in light of technical advances and dissection of the thoraco-abdominal region of a interventional methods of diagnosis and treatment. male cadaver in the Department of Anatomy, The sternalis muscle is a small supernumerary College of Medicine, King Saud University, Riyadh, muscle located in the anterior thoracic region, Kingdom of Saudi Arabia. Both muscles were superficial to the sternum and the sternocostal covered by superficial fascia, located superficial to fascicles of the pectoralis major muscle.2 In the the corresponding sternocostal portion of pectoralis literature, sternalis muscle is called "a normal major and separated from it by pectoral fascia. The anatomic variant"3 and "a well-known variation",4 left sternalis was 19 cm long and 3 cm wide at its although in most textbooks of anatomy, it is broadest part. Its upper end formed a tendon insufficiently mentioned. Yet, clinicians are continuous with that of the sternal head of left surprisingly unaware of this common variation. -
The Levator Scapulae Muscle – Morphological Variations K
International Journal of Anatomy and Research, Int J Anat Res 2019, Vol 7(4.3):7169-75. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2019.335 THE LEVATOR SCAPULAE MUSCLE – MORPHOLOGICAL VARIATIONS K. Satheesh Naik 1, Sadhu Lokanadham 2. *1 Assistant Professor, Department of Anatomy, Viswabharathi Medical College & General Hospital, Penchikalapadu, Kurnool, Andhrapradesh, India. 2 Associate Professor, Department of Anatomy, Santhiram Medical College and General Hospital, Nandyal, Andhrapradesh, India. ABSTRACT Introduction: Anatomical variations of the levator scapulae are important and therefore clinically relevant. The levator scapulae are now believed to be the leading cause of discomfort in patients with chronic tension-type neck and shoulder pain and a link between anatomical variants of the muscle and increased risk of developing pain has been speculated. The results obtained were compared with previous studies. Materials and methods: The study was conducted on 32 levator scapulae muscle of 16 cadavers over a period of 3 years. The dissection of head and neck was done carefully to preserve all minute details, observing the morphological variations of the muscle in the department of Anatomy, Viswabharathi Medical College, Penchikalapadu, and Kurnool. Results: Total 32 levator scapulae muscles were used. All the sample values were measured to 2 decimal places. The average age of the cadavers in the sample was 82.87 years. The oldest cadaver in the sample was 100 years old and the youngest 61 years. Measurements of the proximal and distal attachments and the total length of the muscles were taken. Between 3 and 6 muscle slips were reported at the proximal attachment. -
Effectiveness of Laser Therapy in the Treatment of Myofascial Pain
American International Journal of Contemporary Research Vol. 6, No. 4; August 2016 Effectiveness of Laser Therapy in the Treatment of Myofascial Pain Lorena Marcelino Cardoso Durval Campos Kraychete Roberto Paulo Correia de Araújo Abstract Myofascial pain is a regional neuromuscular dysfunction of multifactorial etiology that is characterized by the presence of trigger points. It is a common cause of chronic pain and a frequent finding in clinical medicine. The proposed therapeutic procedures aim to reduce pain intensity, inactivate trigger points, rehabilitate muscles and preventively eliminate perpetuating factors. The search for effective treatments and non-invasive options is a topic of ongoing study and, among the proposed therapeutic modalities, laser therapy remains controversial. Objective: To analyze the history of laser therapy in the treatment of myofascial pain, the evolution of research on its effectiveness and the establishment of treatment protocols. Methodology: Analytical study of randomized and controlled clinical trials, double-blinded or single-blinded, describing the effects of laser therapy for myofascial pain or myofascial trigger points, published between 2009 and 2013, and available in the databases PUBMED, MEDLINE, LILACS, IBECS, Cochrane Library, KSCI and SciELO. Results: Regarding the effectiveness of laser therapy for the treatment in question, both positive results and results at the same level as the placebo were observed in the studies. The heterogeneity of the trials does not allow the determination of optimal laser parameters for treatment. Conclusion: According to the data from clinical trials conducted in the last five years, it is still not possible to provide definitive conclusions about the effects of laser therapy for myofascial pain or to establish correlations between the observed results and the parameters employed. -
Congenital Bilateral Absence of Levator Scapulae Muscles: a Case Report Stephanie Klinesmith, Randy Kuleszat
CASE REPORT Congenital bilateral absence of levator scapulae muscles: A case report Stephanie Klinesmith, Randy Kuleszat Klinesmith S, Kulesza R. Congenital bilateral absence of levator we report dissection of a cadaveric specimen where the levator scapulae muscles: A case report. Int J Anat Var. 2020;13(1): 66-67. scapulae muscle was absent bilaterally. While bilateral congenital absence of the levator scapular appears to be an extremely rare The levator scapulae muscle is a thin, four-bellied muscle occurrence, the absence of this muscle might put neurovascular spanning the posterior neck and scapular region. Previous case bundles in the posterior neck and scapular region at increased risk reports have documented highly variable origins and insertions of this muscle, with the most common variations being from penetrating trauma or surgical procedures. additional slips and bellies. However, there are no previous Key Words: Levator scapulae; Anatomical variation; Congenital reports demonstrating congenital absence of this muscle. Herein, absence INTRODUCTION he levator scapulae muscle (LSM) is a bilaterally symmetric muscle that Toriginates from the transverse processes of the first through fourth cervical vertebrae and inserts onto the superior angle of medial border of the scapula [1]. The LSM is in contact anteriorly with the middle scalene muscle, laterally with the sternocleidomastoid and trapezius muscles, posteriorly with the splenius cervicis muscle and medially with the posterior scalene muscle [2]. The LSM is innervated by the dorsal scapular nerve, as well as the anterior rami of the C3 and C4 spinal nerves. The primary function of the levator scapulae is elevating the scapula [1], however it has been suggested that it also assists in downward rotation of the scapula [2]. -
The Scientific Basis of Myofascial Trigger Points
The Scientific Basis of Myofascial Trigger Points Robert Gerwin MD, FAAN Johns Hopkins University, Baltimore, MD Etiology of Myofascial Trigger Points Acute Overuse Direct Trauma Persistent Muscular Contraction (emotional or physical cause), i.e,: poor posture, repetitive motions, stress response Prolonged Immobility Systemic Biochemical Imbalance Etiology of MTrPs (updated) low level muscle contractions Dommerholt J, Bron C, and Franssen J: Myofascial trigger points; an evidence-informed review. J Manual & Manipulative Ther, 2006:14(4):203-221. Gerwin RD, Dommerholt J, and Shah J: An expansion of Simons' integrated hypothesis of trigger point formation. Curr Pain Headache Rep, 2004. 8:468-475. uneven intramuscular pressure distribution direct trauma unaccustomed eccentric contractions eccentric contractions in unconditioned muscle maximal or submaximal concentric contractions Other Contributing Factors Associated MTrP Afferent Input from Joints Afferent Input from Internal Organs Stress / Tension Radiculopathy? MTrP referred pain? Both? Diagnostic criteria spot tenderness within the taut band Diagnostic criteria taut band Muscle Fiber Direction Palpation two palpation techniques: • Flat palpation • Pincer palpation Flat Palpation Scientific Basis of Trigger Points Myofascial Trigger Points exhibit a number of characteristics that require explanation: 1. Structural appearance (hardened muscle band) 2. Biochemical features 3. Nature of local and referred pain 4. Response to treatment The science of myofascial trigger points The anatomic basis of trigger points Electrical Activity of trigger points Sympathetic modulation Vascular changes Biochemical physiology of trigger points Sensitization Treatment effects Trigger Point Structure Motor End PLate Hypothesis: Hypercontracted sarcomeres forming dense, contracted band Sikdar S, et al. Novel Applications of Ultrasound Technology to Visualize and Characterize Myofascial Trigger Points and Surrounding Soft Tissue Arch Phys Med Rehabil. -
Manual Or Mechanical Treatment of Myofascial Trigger Points
Myofascial Trigger Point Mini Course MANUAL OR MECHANICAL TREATMENT OF MYOFASCIAL TRIGGER POINTS Laurie Edge-Hughes, BScPT, MAnimSt, CAFCI, CCRT Myofascial Trigger Points • REVIEW: • Video One… • Background, Etiology & Pathology, Diagnosis via Palpation • Video Two… • Palpation & Dry Needling on a Dog • TODAY: • Video Three… • Common canine MTrP sites • MANUAL & MECHANICAL Therapies Copyright Laurie Edge-Hughes 1 Myofascial Trigger Point Mini Course Myofascial Trigger Points • Myofascial Trigger points – clinically • Common locations (around the shoulder): • Infraspinatus • Triceps • Latissimus Dorsi / Teres Major Clinical Signs: • Pain on palpation • Subtle lameness • Movement restrictions Myofascial Trigger Points • Myofascial Trigger points – clinically • Common locations (around the back): • Iliocostalis, • Quadratus Lumborum, • Iliopsoas • Clinical signs • Pain on palpation • Rounded back appearance (back pain) • May seem stiff Copyright Laurie Edge-Hughes 2 Myofascial Trigger Point Mini Course Myofascial Trigger Points • Myofascial Trigger points – clinically • Common locations (around the hip): • Quadriceps & Sartorius • Pectineus / Adductors Note: Peroneus longus also identified in the • Semi-membranosus / Semi-tendinosus literature • Gluteus Medius & Deep Gluteal • TFL • Gracilis • Clinical Signs: • Pain on palpation, Subtle lameness, Movement restrictions Myofascial Trigger Points Copyright Laurie Edge-Hughes 3 Myofascial Trigger Point Mini Course Myofascial Trigger Points • Myofascial Trigger points – canine research • Janssens -
Certification Examination for Myofascial Trigger Point Therapists
Certification Examination for Myofascial Trigger Point Therapists 2019 Testing Periods Application Deadline: December 3, 2018 Testing Begins: Saturday, January 5, 2019 Testing Ends: Saturday January 19, 2019 Application Deadline: June 3, 2019 Testing Begins: Saturday, July 6, 2019 Testing Ends: Saturday July 20, 2019 TABLE OF CONTENTS CERTIFICATION ................................................................................................................................................................- 1 - PURPOSES OF CERTIFICATION ........................................................................................................................................- 1 - ELIGIBILITY REQUIREMENTS ............................................................................................................................................- 1 - EXAMINATION ADMINISTRATION ...................................................................................................................................- 1 - ATTAINMENT OF CERTIFICATION AND RECERTIFICATION..............................................................................................- 2 - REVOCATION OF CERTIFICATION .....................................................................................................................................- 2 - COMPLETION OF APPLICATION .......................................................................................................................................- 2 - INTERNATIONAL TESTING ...............................................................................................................................................- -
Understanding of Myofascial Trigger Points (2): Acupuncture Vs Dry Needling
Open Access Physical Medicine and Rehabilitation - International Special Article - Acupuncture and Rehabilitation Understanding of Myofascial Trigger Points (2): Acupuncture vs Dry Needling Huang QM1,2*, Xu AL1, Ji LJ1 and Pang B1 1School of Kinesiology, Shanghai University of Sport, Abstract Shanghai, China The use of acupuncture and dry needling has been widely debated, and 2Department of rehabilitation, Hudong Hospital, the main point of contention is whether dry needling has been derived from Shanghai, China acupuncture. This paper comprehensively discusses the two aspects of basic *Corresponding author: Huang QM, School of theory, diagnosis and treatment of traditional acupuncture, meridian, acupoints, Kinesiology, Shanghai University of Sport, 188 Henreng and myofascial trigger points (MTrPs). Except the difference between two Road, Yangpu Area, Shanghai, China theories, many aspects are related in terms of clinical practice and basic laboratory studies. Nevertheless, two aspects are highly similar in terms of Received: March 28, 2018; Accepted: May 04, 2018; treatment action, applicable disease, and physiological experiments. Therefore, Published: May 11, 2018 MTrP theory is considered a basis for modern acupuncture, which is different from traditional acupuncture theory. MTrP is also easily accepted and learned by individuals with a background in modern medicine and those with knowledge in traditional acupuncture. Hence, MTrPs may be the precise acupoints in traditional Chinese medicine under modern scientific research, and meridian involves the synthesis of referred pain, nerves, vessels, and fascia mechanics. The scientific basis of Chinese and Western medicines should be coherent, although the origin of these two theories varies because of the distinctiveness of the identity between ancient and modern knowledge. -
Sonographic Tracking of Trunk Nerves: Essential for Ultrasound-Guided Pain Management and Research
Journal name: Journal of Pain Research Article Designation: Perspectives Year: 2017 Volume: 10 Journal of Pain Research Dovepress Running head verso: Chang et al Running head recto: Sonographic tracking of trunk nerve open access to scientific and medical research DOI: http://dx.doi.org/10.2147/JPR.S123828 Open Access Full Text Article PERSPECTIVES Sonographic tracking of trunk nerves: essential for ultrasound-guided pain management and research Ke-Vin Chang1,2 Abstract: Delineation of architecture of peripheral nerves can be successfully achieved by Chih-Peng Lin2,3 high-resolution ultrasound (US), which is essential for US-guided pain management. There Chia-Shiang Lin4,5 are numerous musculoskeletal pain syndromes involving the trunk nerves necessitating US for Wei-Ting Wu1 evaluation and guided interventions. The most common peripheral nerve disorders at the trunk Manoj K Karmakar6 region include thoracic outlet syndrome (brachial plexus), scapular winging (long thoracic nerve), interscapular pain (dorsal scapular nerve), and lumbar facet joint syndrome (medial branches Levent Özçakar7 of spinal nerves). Until now, there is no single article systematically summarizing the anatomy, 1 Department of Physical Medicine sonographic pictures, and video demonstration of scanning techniques regarding trunk nerves. and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, In this review, the authors have incorporated serial figures of transducer placement, US images, Taipei, Taiwan; 2National Taiwan and videos for scanning the nerves in the trunk region and hope this paper helps physicians University College of Medicine, familiarize themselves with nerve sonoanatomy and further apply this technique for US-guided Taipei, Taiwan; 3Department of Anesthesiology, National Taiwan pain medicine and research. -
The Surgical Anatomy of the Mammary Gland. Vascularisation, Innervation, Lymphatic Drainage, the Structure of the Axillary Fossa (Part 2.)
NOWOTWORY Journal of Oncology 2021, volume 71, number 1, 62–69 DOI: 10.5603/NJO.2021.0011 © Polskie Towarzystwo Onkologiczne ISSN 0029–540X Varia www.nowotwory.edu.pl The surgical anatomy of the mammary gland. Vascularisation, innervation, lymphatic drainage, the structure of the axillary fossa (part 2.) Sławomir Cieśla1, Mateusz Wichtowski1, 2, Róża Poźniak-Balicka3, 4, Dawid Murawa1, 2 1Department of General and Oncological Surgery, K. Marcinkowski University Hospital, Zielona Gora, Poland 2Department of Surgery and Oncology, Collegium Medicum, University of Zielona Gora, Poland 3Department of Radiotherapy, K. Marcinkowski University Hospital, Zielona Gora, Poland 4Department of Urology and Oncological Urology, Collegium Medicum, University of Zielona Gora, Poland Dynamically developing oncoplasty, i.e. the application of plastic surgery methods in oncological breast surgeries, requires excellent knowledge of mammary gland anatomy. This article presents the details of arterial blood supply and venous blood outflow as well as breast innervation with a special focus on the nipple-areolar complex, and the lymphatic system with lymphatic outflow routes. Additionally, it provides an extensive description of the axillary fossa anatomy. Key words: anatomy of the mammary gland The large-scale introduction of oncoplasty to everyday on- axillary artery subclavian artery cological surgery practice of partial mammary gland resec- internal thoracic artery thoracic-acromial artery tions, partial or total breast reconstructions with the use of branches to the mammary gland the patient’s own tissue as well as an artificial material such as implants has significantly changed the paradigm of surgi- cal procedures. A thorough knowledge of mammary gland lateral thoracic artery superficial anatomy has taken on a new meaning.