Cervical Myofascial Pain Workup

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

Approach Considerations

As previously stated, the diagnosis of myofascial pain is clinical, with no confirmatory laboratory tests available. In addition, imaging studies often reveal nonspecific change only and typically are not helpful in making the diagnosis of cervical myofascial pain.

However, cervical myofascial pain can be present at the same time as other, more serious medical conditions. If the patient's symptoms are resistant to traditional treatment for cervical myofascial pain, further workup is indicated. If a history of trauma exists, order cervical flexion/extension films to rule out the possibility of instability.

Magnetic resonance imaging (MRI) may be helpful in ruling out any significant abnormality within the structure of the cervical vertebrae or spinal canal. The cervical discs also may be evaluated. If the pain is in the shoulders or chest wall, be aware that visceral pain may refer to these areas and even produce some myofascial findings on examination. Be open-minded to the possibility that another problem also may be present.

It may also be reasonable, depending on the clinical presentation, to check for indicators of inflammation, assess thyroid function, and perform a basic metabolic panel to rule out a concomitant medical illness.

Travell and Simons described a study looking at lactate dehydrogenase (LDH) isoenzymes in which a shift was noted in the distribution of the isoenzymes, with higher levels of LDH1 and LDH2, while the total LDH remained within normal limits. [2]

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Electrophysiologic Studies

Several research articles have attempted to identify changes on electromyograms/nerve conduction velocity studies that may be unique to patients with myofascial pain. The research has been somewhat contradictory, with some studies finding no real electromyographic activity and others finding nonspecific electrical activity.

Studies by Simons and by Hobbard and Berkoff described low-amplitude action potentials recorded at the region of the myofascial trigger point. Spontaneous electrical activity apparently can be detected using high-sensitivity recordings at the site of the trigger point. The spontaneous electrical activity may be a type of endplate potential.

A study by Ballyns et al describes the use of sonoelastography in classifying myofascial trigger points by active, latent, and normal sites. Although not yet clinically useful, employing sonoelastography to assess the trigger point areas and pulsatility index may help to determine myofascial pain syndrome's natural history. [5]

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