Myofascial pain syndrome

The myofascial pain syndrome (MSS) is a condition that is characterized by pain in the musculoskeletal system , which is not characterized by joints , periosteum , muscle disorders or other neurological disorders originate. In contrast to fibromyalgia , MSS always has a locally limited pain condition.

root cause

Myofascial pain syndrome is caused by an overly sensitive focus in a muscle called the trigger point . It is caused by overloading a muscle, which leads to a persistent contraction of individual sarcomeres . This leads to a locally limited insufficient supply of oxygen and an inhibition of the re-uptake of calcium in the sarcoplasmic reticulum and thus a permanent contraction. This contracture knot is usually palpable. The release of messenger substances leads to pain that can spread to neighboring muscle areas through spinal reflexes .

The starting point for muscle overload can be stress, the slightest damage from repetitive movements, malnutrition, hormonal disorders, immobility , muscle weakness , cramps or neurological damage (damage to individual nerve roots ). Hypothermia (e.g. clothes that are too thin in winter) can also lead to the development of trigger points.

Clinical picture and diagnostics

Characteristic is a local pressure-sensitive point, a hard, tense muscle bundle (muscular tension, taut band ) and a radiating of the pain into the so-called transfer zone when pressure is applied to the trigger point. When pressure is applied to the trigger point, there is a reflex twitching of the muscle fibers there (local twitching reaction LZR). In addition, there is limited mobility and muscle weakness in the area. A stretching of the muscle is only possible to a limited extent due to the pain.

If the pain follows a dermatome when the pressure is applied, then it is not a trigger point. In this way, trigger points can always be clearly distinguished from neurological causes .

Muscle tension and reflex twitching are absent at the tender points of fibromyalgia , but MSS trigger points occur simultaneously in 70% of fibromyalgia patients.

treatment

The treatment is mainly carried out through physiotherapy ( trigger point therapy , massage ). Heat treatments such as B. natural mud , red light or a grain pillow, can also have a positive influence after the actual therapy by stimulating the metabolism.

In complicated forms, muscle relaxants such as tolperisone or methocarbamol can be used. In the case of therapy-resistant forms, invase treatment is carried out by infiltrating the trigger point. A needle is brought into the trigger point and pushed back and forth ( dry needling ); if necessary, isotonic saline solution , a local anesthetic or botulinum toxin are injected.

literature

• Hans-Christoph Diener, Christoph Maier (editor): The pain therapy: Interdisciplinary diagnosis and treatment strategies with access to the Elsevier portal . Elsevier, Urban & Fischer Verlag, 3rd edition 2008, ISBN 9783437215414 , p. 133 ff.
• Janet G. Travell et al .: Manual of Muscle Trigger Points . 1. Upper extremity, head and thorax . 2nd edition 2002, Elsevier Urban & Fischer, ISBN 343741402X .

Guidelines

S3 guideline for fibromyalgia syndrome: definition, pathophysiology, diagnostics and therapy of the German Interdisciplinary Association for Pain Therapy (DIVS). In: AWMF online (as of 2012)

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !