lundi 17 octobre 2016

Chronic Musculoskeletal pain, N°2, Myofascial pain syndrome.

Chronic Musculoskeletal pain, N°2, Myofascial pain syndrome.

1.-The pain
*-* The active TP, is a sensitive, irritable, and painful nodule. It can be painful during movements or even at rest. 
The pain increases when a contraction is performed against fixed resistance.
Local spontaneous pain of the TP is reproduced by palpation, which also reproduces, regional pain, at distance from the TP, so-called referred pain.
 *-* For a latent TP, activation, by palpation, pressure, physical activity, arouses the local pain of the TP and reproduces the regional or referred pain, sometimes the only pain spontaneously felt by the Patient.                           
2 - Painful tendons
Contracture of the muscle fibers also affected the tendon which can become inflamed and painful.
3. - Muscular cord or Taut-band
It is a bundle of muscular fibers contracted, more or less deep, over the length of the muscle, the width of a thread or wider, 3-4mm.
4.- In the middle of the taut band, one finds, the TP:
A sensitive area of 2.5 mm in diameter. Powering up the muscle or its palpation causes an exquisite pain at the level of the TP corresponding to the pain described by the Patient. The active TP is sometimes surrounded by adipose tissue. 
5. - Local Twitch Response_ LTR.
It is a specific reaction of the myofascial pain syndrome. It is a spinal reflex, a transient contraction of the muscle fibers of the cord in response to induced or spontaneous.
When palpation is negative, the 'taut band' contraction, referred and locale pain can be caused by inserting a needle into the TP.
OOo There is a positive correlation between the localized contractile response and the therapeutic outcome.
6 - Referred pain.  
Perfectly described in the princeps work of Travell and Simons. It is located at a more or less distance from the TP. It is constant for a given individual and variable from one individual to another. It can range from a postural deviation to severe and disabling pain that affects the patient’s quality of life and forced him to rest. In the area of referred pain, are noted paresthesia / a hyperesthesia, hyper-excitability of the motor units.
7. - In response to the digital pressure of the TPs or the Dry / Wet Needling, there is a muscular response either in the form of fasciculation or a more extensive muscle flexion or jump sign.
• There is a partial muscular impotence: Partly attributable to the taut band whose muscular strength is diminished.
The muscle is weakened by muscular atrophy, reaction to the avoidance of the activation of the painful muscle and appeal to the agonist or antagonist muscles in which can also be created secondary TPs either without atrophy or (without) painful origin.
Muscular weakness contributes to postural deviation secondary to pain.
The range of stretching is limited: Passive or active stretching increases the pain. This results in a restriction of active and passive mobility due either to motion avoidance or to adherence to chronic TP. 
The TP compromises muscle coordination.
8 - Neuro-Vegetative Symptoms
Pallor, coldness, sweating symptoms or abnormal sweating, lacrimation, pilo-motor activity (goose bumps), flushing, edema, ptosis, nausea depending on the painful intensity...
The muscle where the primary TP locates is more sensitive to cold or weather changes.
Other neurological symptoms may be associated with: Paresthesia, blurred vision, shaking and tremors.

MICROSCOPIC examination,
It is unusual.
Part of the muscle fiber is contracted in a small thickened area and the rest of the thinner fiber is stretched.
Several of these contracted muscle fibers in the same area are probably what is felt as a "node" in the muscle. These muscle fibers are not available for use because they are already contracted, which explains that one cannot contract a stiff muscle housing TPs.

The sustained contraction probably leads to the release of chemicals, sensitizers, producing the pain felt by TP pressure.  Some structural changes can be irreversible if TPs are not treated promptly. The contractile portions, at the center of the TP can be separated and retracted at each end, leaving, in the center of the TP an empty part.

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