Cervical Myofascial Pain

Updated: Aug 18, 2016
  • Author: C Douglas Phillips, MD, FACR; Chief Editor: Dean H Hommer, MD  more...
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Overview

Background

Pain attributed to muscle and its surrounding fascia is termed myofascial pain, with cervical myofascial pain thought to occur following either overuse or trauma to the muscles that support the shoulders and neck. In the cervical spine, the muscles most often implicated in myofascial pain are the trapezius, levator scapulae, rhomboids, supraspinatus, and infraspinatus. (See Etiology.) [1]

Myofascial pain in any location is characterized on examination by the presence of trigger points located in skeletal muscle. A trigger point is defined as a hyperirritable area located in a palpable, taut band of muscle fibers (see the image below). (See Etiology, Presentation, and Treatment.)

Schematic of a trigger point complex of a muscle i Schematic of a trigger point complex of a muscle in longitudinal section. A: The central trigger point (CTrP) in the endplate zone contains numerous electrically active loci and numerous contraction knots. A taut band of muscle fibers extends from the trigger point to the attachment at each end of the involved fibers. The sustained tension that the taut band exerts on the attachment tissues can induce a localized enthesopathy that is identified as an attachment trigger point (ATrP). B: Enlarged view of part of the CTrP shows the distribution of 5 contraction knots. The vertical lines in each muscle fiber identify the relative spacing of its striations. The space between 2 striations corresponds to the length of 1 sarcomere. The sarcomeres within one of these enlarged segments (ie, contraction knot) of a muscle fiber are markedly shorter and wider than the sarcomeres in the neighboring normal muscle fibers, which are free of contraction knots.

Descriptions of myofascial pain date back to the mid-19th century, when Froriep described muskelschwiele, or muscle calluses. He characterized these calluses as tender areas in muscle that felt like a cord or band associated with rheumatic complaints. In the early 1900s, Gowers first used the term fibrositis to describe muscular rheumatism associated with local tenderness and regions of palpable hardness.

In 1938, Kellgren described areas of referred pain associated with tender points in muscle. In the 1940s, Janet Travell, MD, began writing about myofascial trigger points. Her text, written in conjunction with David Simons, MD, continues to be viewed as the foundational literature on the subject of myofascial pain. [2]

The primary concern for patients with cervical myofascial pain is chronicity. Recurrence of myofascial pain is a common scenario. Prompt treatment prevents other muscles in the functional unit from compensating and, consequently, producing a more widespread and chronic problem. Migraine headaches and muscle contraction headaches are known to occur frequently in the patient with myofascial pain. [3] Temporomandibular joint (TMJ) syndrome also may be myofascial in origin. (See Prognosis, Presentation, Treatment, and Medication.) [1]

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Etiology

Cervical myofascial pain is thought to occur following either overuse or trauma to the muscles that support the shoulders and neck. Common scenarios among patients are recent involvement in a motor vehicle accident or performance of repetitive upper extremity activities.

In the cervical spine, the muscles most often implicated in myofascial pain are the trapezius, levator scapulae, rhomboids, supraspinatus, and infraspinatus. [1] Trapezial myofascial pain commonly occurs when a person with a desk job does not have appropriate armrests or must type on a keyboard that is too high.

Other issues that may play a role in the clinical picture of cervical myofascial pain include endocrine dysfunction, chronic infections, nutritional deficiencies, poor posture, and psychological stress.

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Epidemiology

Occurrence in the United States

Myofascial pain is thought to occur commonly in the general population. As many as 21% of patients seen in general orthopedic clinics have myofascial pain. Of patients seen at specialty pain management centers, 85-93% have a myofascial pain component to their condition.

Sex- and age-related demographics

Cervical myofascial pain occurs in both sexes, but with a predominance among women. Myofascial pain seems to occur more frequently with increasing age until midlife. The incidence declines gradually after middle age.

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Prognosis

When the patient with cervical myofascial pain undergoes appropriate treatment (eg, physical therapy, massage therapy, stretch and spray, trigger point injections), the prognosis is generally good. However, recurrence can be a common scenario. Outcomes seem to be better when treatment is initiated early in order to prevent compensation patterns that exacerbate pain. Increased mortality is not associated with cervical myofascial pain.

A Turkish study found evidence that patient disability in chronic myofascial pain is most strongly linked to the duration of pain. The report's assessment was based on data collected from 103 female patients with the chronic disorder and from 30 healthy female participants, using the Neck Pain and Disability Scale, the Beck Depression Inventory, and a visual analog scale, as well as pain pressure threshold measurements from common cervical myofascial pain trigger points. [1]

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Patient Education

Patients with cervical myofascial pain need to be educated regarding the factors or underlying problems that may contribute to their pain and loss of mobility. The physical therapist can educate the patient on proper exercise habits and instruct them in a home exercise program for stretching and reconditioning. The patient also may benefit from specific exercises and strategies to improve posture awareness and body mechanics with activities of daily living. If poor workplace ergonomics contribute to the patient's condition, offer instruction in proper ways to modify and revamp the workstation. Cervical myofascial pain is a treatable condition if the patient is educated on the condition and takes an active role in the recovery process.

For patient education information, see Temporomandibular Joint (TMJ) Syndrome, Fibromyalgia, and Chronic Pain.

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