The soft tissues of the neck, shoulder, and back may have different degrees of traumatic aseptic inflammatory reactions to muscles, fascia, ligaments, joint capsule, periosteum, fat, and tendons after acute injury or long-term chronic strain. Upper respiratory tract infection or other inflammatory diseases causing fever, climate change such as cold and wet and excessive physical exertion are all triggering factors. Soft tissue traumatic aseptic inflammation and pain stimulate the muscle to produce a persistent contraction state, muscle tension, long-term muscle spasm causes local soft tissue vasospasm, insufficient blood supply to the muscle and fascia, nutritional disorders, tissue aseptic inflammation aggravated, so forming a vicious circle, making the pain more aggravated.
Diagnostic criteria: divided into major criteria and minor criteria.
1.Main criteria.
(1) Complaint of regional pain.
(2) Abnormal sensation in the area of expected distribution of the complained pain or trigger point involved pain.
(3) palpable tension zone in the affected muscle.
(4) Intense point-like tenderness at a point within the tension zone.
(5) At the time of measurement, there is some degree of motor restriction.
2. Secondary criteria.
(1) repetition of the complained clinical pain or sensory abnormality at the point of pressure pain.
(2) Local convulsive response induced by lateral grasping touch or needle pricking into the trigger point of the zonule.
(3) Stretching the muscle or injecting the trigger point to relieve pain.
The diagnosis can be confirmed if 5 major and at least 1 minor criteria are met.
3. Clinical diagnostic criteria.
(1) Diffuse stabbing pain in the low back or buttocks; tightness/heavy pressure/heaviness is evident over the transverse process or iliac crest, often involving the lateral thigh but not transmitted below the knee.
(2) Unfavorable lumbar movement, difficulty in turning, and bending position for a short time can cause pain.
(3) Ischemic pain: cold/fatigue, cold weather, during sleep at night, pain in the morning. relieved by activity and regained by fatigue or in the evening.
(4) pressure points: local muscle tension and or spasm hardening, pressure pain in the paraspinal, transverse process, along the subcostal or iliac crest, fixed position, and painful hard nodes or painful muscle cords can be felt in the deep part.
4.MRI examination: typical cases can show local muscle atrophy or enlargement and thickening of muscle membrane.
Treatment
1, injection therapy: 0.25% lidocaine 20mL, dexamethasone 5mg, using the cross infiltration block method of treatment of myofasciitis, every other day once, 3 times for a course, the efficacy of poor dexamethasone replaced by trimethoprim 40mg. botulinum toxin injection plus muscle tension method, commonly used botulinum toxin has A and B2 type, mostly with A type, if A type failure can be replaced with B type.
2, drug treatment: NSAIDS class drugs, analgesics, muscle relaxants, antidepressants and corticosteroids. nSAIDS class drugs can reduce pain, but long-term treatment there are common gastrointestinal risks, and the symptoms are easy to relapse after stopping the drug. Small doses of codeine can be taken for short periods of time when pain is unbearable. Aspirin is helpful in relieving myofascial pain. To reduce symptoms of gastrointestinal irritation, over-the-counter enteric aspirin or timed-release aspirin may be used. Paracetamol does not cause gastrointestinal irritation and has a good analgesic effect on myofascial pain. These drugs provide only temporary relief of pain and are not promising for the long-term efficacy of reducing simple myofascial pain. At present, commercially available muscle relaxants have general efficacy on trigger points of myofascial pain patients.
Physiotherapy: At present, physiotherapy includes: isometric contraction relaxation exercise, acupressure or ischemic compression, muscle massage, cold, heat, electrotherapy, low-frequency, Lewit technique (isometric contraction after compartmentalization), ultraviolet therapy, ultrasound, ultra-laser and high-voltage pulsed direct current stimulation. Among them, isometric contraction relaxation exercise not only reduces pain, but also restores neuromuscular function and improves adaptability, which is also one of the important means to consolidate the therapeutic effect.
4.Treatment for trigger point: In the clinical application of treating myofascial pain syndrome caused by myofascial trigger point, we should not only treat the symptoms, but also emphasize the radical treatment of myofascial trigger point. Most patients with trigger point pain have vitamin deficiencies in the organism and normal low line vitamin levels, so treatment should be accompanied by supplementation with various vitamins.