Myofascial pain syndrome (MPS) is a condition in which people have at least one myofascial injury in their lifetime, and the long-term pain caused by local adhesion contracture of the injured myofascia is named Myofascial Pain Syndrome (MPS).
1, local muscle pain: chronic persistent soreness or dull pain, pain is tightness or heavy pressure, the lumbar, back, sacral, hip, leg, knee, foot plantar, neck, shoulder, elbow or wrist can occur.
2.Ischemic pain: pain can be triggered by local cold or general fatigue, cold weather, waking up with pain during late night sleep, stiffness and pain in the morning, relieved after activity but often aggravated after long working hours or in the evening, and can be aggravated when inactive or overactive for a long time or even when emotionally upset.
3.Fixed pressure pain point: During physical examination, the patient is found to have tension, spasm, bulge, contracture or stiffness in one side or local muscles. The location of the pressure point is often fixed near the starting point of the muscle or the intersection of two groups of muscles in different directions, and painful hard nodes or painful muscle cords can be felt in the deep part of the pressure point.
4. There may be a history of local or adjacent injury, and the incidence is more frequent in women than in men.
The diagnostic criteria for MPS in the United States are
1, there are fixed painful areas and pressure points on the attachment points of tendons or muscle belly. Pressing on the painful point may cause regional dispersed pain not distributed according to the nerve root sensation.
2.The pain worsens when the temperature decreases or when fatigue is present.
3.Treatment to increase blood flow to the muscles may reduce pain.
4.Exclude local occupying or destructive lesions.
The treatment principles of MPS are.
1.De-cause: such as anti-rheumatoid, anti-inflammatory, loosening of scars.
2.Improve blood supply: exercise, massage, heat therapy (infrared, laser, cupping, acupuncture), etc. are effective but not healing, with a high recurrence rate.
3.Anti-inflammatory and analgesic: can reduce symptoms and improve the quality of life.
4.Elimination of tenderness points: the application of minimally invasive techniques to loosen local adhesions can prevent recurrence and aggravation of MPS, with good long-term effects. Minimally invasive treatment techniques include Kawasaki block for acute pain, small needle separation for those with limited pain in the chronic phase radiofrequency thermal coagulation for loosening of dangerous areas, etc.
5.Physical exercise: anti-gravitational muscle exercise.
6.Anti-depressant treatment.
Muscles and ligaments are the power base of various activities of the human body, and their end devices are their respective muscles attached to the bones, which are the power transmission hubs that drive the bones and joints, and also the parts where stresses are concentrated and intersected, so it is extremely easy to be damaged. Repeated injury to the local muscle, when the injury healed can leave scars or adhesions, scar tissue can reduce the number of local blood vessels or small diameter, the occurrence of local microcirculation blood flow regulation ability to reduce the muscle blood supply and anaerobic work ability to lose. The local ischemia of the muscles causes pain due to stimulation of the peripheral nerves, and the patient cannot tolerate prolonged physical activity or even sedentary activities. For example, long-term incorrect posture or psychological depression can cause physiological contracture at the local muscle joint level, long-term repeated muscle spasms cause muscle ischemia, sterile exudation, scar formation, local myofascial often undergo postural load and extreme tension, fatigue causes postural injury, repeated exertion causes muscle micro-tear injury, and pain-causing substances appear around the myofascial microvascular reaction zone. Rheumatoid myositis, ankylosing spondylitis or viral myositis cause peripheral nerve compression due to muscle swelling, which may form nociceptive sensitive points or painful muscle sclerosis for a long time and experience a complex intertwined reaction process of long-term local irritation, inflammation, healing, hyperplasia or scarring, with painful local tissues and calcification of inflammatory exudate deposits and development of myoclonus. Hypoxia or lack of energy metabolism may be secondary to a decrease in local blood flow and is an important mechanism of CMPS painfulness that can cause muscle dysfunction and tissue destruction, therefore any means of improving microcirculation to the muscles and nerves even local massage or walking can provide some relief from the painful symptoms of CMPS.
Pathological features of painful nodules.
1, a bundle of muscle fibers in a muscle surrounded by a sterile inflammatory myofibrils that are stiffer.
2, A lesioned dermal nerve.
3, Hyperplastic inflammatory fatty connective tissue, closely associated with deep fascia.
4, The site where the motor nerve enters the muscle. Painful nodules mostly occur in the supraspinous ligament, interspinous ligament, posterior laminae, supraspinous muscle group, intertransverse muscle group, occipital ring fascia, levator scapulae, trapezius, rhomboid, psoas, sacrospinous, and so on.
The release of local adhesions of myofascia is the basic technique for eliminating the tenderness point of MPS. Patrick believes that the key to needling is the mechanical destruction of the pain trigger point and not in what potion is injected, and advocates that the injection allows the needle tip to repeatedly explore the area to separate the tissue and mechanically destroy the pain trigger point. Surgical separation of myofascia was popular in the 1950s, and although effective, it is now largely replaced by minimally invasive techniques. Currently, the following are available for MPS: saline injection for hydrodynamic separation of painful spots (Kawasaki therapy), steroid injection for lysis of local nodal tissue (closure therapy), microethanol or phenol glycerin injection for the separation of myofascial adhesions by destroying local tissue cellular proteins, small needle knife therapy for direct incision or stripping of myofascial scar points, burning of moxa on the pierced needle bar to make the needle channel The intensive warm needle therapy with the coagulation of cellular proteins and the growth of capillaries. Radiofrequency thermal coagulation therapy, which is being explored, is also similar to the intensive warm needle therapy mechanism and is particularly suitable for myofascial release in areas containing important nerves, such as the neck or buttocks. Eighty-five percent of patients with chronic pain disorders have primary or secondary CMPS, such as osteoporosis, disc herniation, cervical spondylosis, posterior branch syndrome, osteoarthritis, or ankylosing spondylitis. Pain relief in the myofascial component is an important part of the overall treatment plan, so it is important to clarify the diagnosis and plan and understand the patient before treatment begins. Elderly or frail patients with myofasciitis in multiple parts of the body, often with hypertension, diabetes, cardiopulmonary, cerebrovascular, mental or psychological disorders, should be treated in a planned and comprehensive manner.
Radiofrequency thermocoagulation: The instrument passes a beam of high frequency current of about 300 KHZ through the electrode, causing the ionic oscillating masses in the tissue around the electrode to rub against each other to generate heat, forming the required range of protein coagulation foci in the tissue and local cell destruction occurs. We apply RF needles to reach and thermally coagulate the tender points of myofasciitis to achieve separation of tissue adhesions, loosen contractures and promote local tissue blood flow supply similar to intensive warm mass needles without their environmental pollution disadvantages. The radiofrequency instrument can also adjust the size and time of radiofrequency output power, precisely control the temperature, time, degree and range of thermal coagulation of local tissue heating, and can cauterize the local hyperplastic peripheral nerves. The instrument has a nerve stimulation function to identify the nature of the tissue where the needle tip is located and the important nerves within at least 3 CM of the needle tip, which is especially suitable for treatment in myofascial areas containing important nerves such as the pear-shaped muscle area, near the intervertebral foramen and the root of the thigh. Radiofrequency thermocoagulation has some local pain after puncture, heating and treatment, and the application of analgesics is advocated for prevention and treatment. After rehabilitation, attention should be paid to educating patients to correct poor posture and strengthen muscle exercise to reduce MPS recurrence. The radiofrequency relaxation technique is flexible and controllable and can be better adapted to the specific situation of each patient, and the operation can be discontinued at any time when discomfort occurs during treatment. Therefore, radiofrequency treatment of CMPS, with the advantages of good analgesia and controllability, has shown good efficacy without serious side effects.