2. Myofascial pain
syndromeFrench physcian Baillou Muscular rheumatism
1950s Travell and Rinzler referred Myofascial pain
A common non-articular local musculoskeletal pain
syndrome caused by myofascial trigger points
located at muscle, fascia, or tendinous insertions.
Affecting ~ 95% of people
3. the presence of
Myofascial trigger points
(MTrPs)
Hyperirritable spot, usually within a taut band of skeletal
muscle
11. • A trigger point & taut band
• Referral of pain to a zone of reference
• Reproduction of the patient’s usual pain
• Local tenderness
• Local twitch response
• Painfully restricted range of motion,
• Muscle strength limited by pain
14. Gerwin described the
following features:-
1) Tender spot found in a taut band of muscle
2) An LTR and/or referred pain to distant sites
3) Restricted range of motion;
4) Reproduction of the patient’s pain complaint
5) Regional muscle weakness
6) Autonomic symptoms
15. Limitation
s :1) Not an objective, reliable, and sensitive method of
diagnosis and measurement of treatment efficacy
2) Can’t make Quantitative comparisons of the tissue
properties before and after treatment;
3) Can’t Differentiate among active MTrPs, latent
MTrPs, and palpably normal tissue;
26. Clinical examination involves tests that restrict
extension of the thigh at the hip.
• ↑pain with active SLR, which is ↓ with passive SLR.
• Extension of the leg at the hip in the lateral
decubitus position often increases the pain.
• Pressure over the trochanter tenderness of the
iliacus and psoas muscles
27. QUADRATUS
LUMBORUM
lateral flexor and stabilizer of the lumbar spine.
•Extension of lumbar vertebral column.
•Fixes 12th rib during forced expiration.
•Elevates ilium bone
28.
29. Clinical feature:--
-• weight-bearing posture↑ pain,
• Discomfort turning over in bed.
Relief unload the lumbar spine of the upper
body's weight ( support and stabilize their
upper body with hands )
coughing or sneezing can exacerbate the pain.
32. Gluteal Muscles
• Gluteus Maximus, gluteus medius, gluteus,
minimus
• The gluteals - allow you to walk and move your legs
in, out, and back.
• common source of low back pain – (G. medius)
• low back pain, also felt over the sacrum & buttock..
41. Risk Factors
leg length discrepancy,
abnormal gait pattern,
trauma,
heavy physical exertion,
pregnancy.
scoliosis,
lumbar and sacrum fusion surgery
42. Local tenderness present in the region of the SIJ
+ve Clinical SI joint stress tests (painful).
+ve diagnostic interventional procedure
(completely relieves the pain)
44. Symptoms :
Paramedian Low back pain –
U/l or b/l
Unilateral Buttock, hip or Thigh
pain
↑on sitting , relieves on
standing
LBP with radiculopathy (non
dermatomal)
62. History
• Groin pain M.C.
• Thigh pain & buttock pain
• Pain, stiffness and difficulty doing activities
degenerative disease
• Referred to buttock and lower extremity
• Peritrochanteric area pain with mild swelling
• Complaints of clicking, catching, snapping, etc.
75. Resisted hip abduction release test
Sudden release will increase the pain in the lateral thigh over the
greater trochanter which may indicate trochanteric bursitis.
Mps causing lbp, history & physical examination
Si joint & hip joint- history , phy ex, investigations
“hyperirritable spot, usually within a taut band of skeletal muscle or in the muscle’s fascia, that is painful on compression and that can give rise to characteristic referred pain, tenderness, and autonomic phenomena
= My Other VAN MET IN EGYPT
stimuli = Maggie Simpson Resists Talking
variablr durn(second, hours, or days).
Current diagnostic standards for myofascial pain rely on palpation for the presence of MTrPs in a taut band of skeletal muscle
local twitch response (LTR),,, upon manual palpation or needling of the tender spot
through pressure on an active MTrP;
MTrPs. focal hypoechoic (darker) areas with
a heterogeneous echotexture.
indicating a localized stiffer region are visible.,,,, Blood flow reversal in diastole was associated with active MTrPs, indicating a highly resistant vascular bed.
The actions of psoas major are flexion and lateral rotation of the thigh at the hip. It also flexes the trunk at the hip and flexes the trunk laterally
Joint between articular surfaces on sacrum and iliac bones. Only the anterior part is a true synovial joint. The posterior part is a fibrous tissue, strong ligaments …. Sacroiliac Joint : Large synovial joint about 1-2 mm wide
relatively immobile
Years of stress on the SI joint can eventually wear down the cartilage and lead to osteoarthritis. ...
Hip is flexed, abducted and externally rotated.
One leg hangs over the edge of the table and the other hip and knee are flexed towards the patient's chest. The examiner applies firm pressure to the knee being flexed to the patient's chest and a counter-pressure is applied to the knee of the hanging leg, towards the floor.
: The patient lies supine and the examiner applies a posteriorly directed force to both anterior superior iliac spines. The presumed effect is a distraction of the anterior aspects of the SIJ
synovialis jointThe Ball & socket, polyaxial,formed by the joint articulation of the rounded head of the like-and the cup femur & acetabulam of the pelvis
Both joint surfaces are covered with a strong but lubricated layer called articular hyaline cartilage except fovea
The cuplike acetabulum forms at the union - of three pelvic bones,, A lip of fibrocartilage called labrum acetabulare is also found.
the strongest ---iliofemoral ligament…… Nerve to rectus femoris (femoral nerve).
-Br. From the anterior division of obturator,,,,,,,,nerve.,,,,,Nerve to quadratus femoris.
weakness in the hip abductor muscles: gluteus medius and gluteus minimus
The normal hip flexion is 135°,Normal hip extension is 25°. , Normal abduction is 45-50°. .,,Normal hip adduction is 30°. ,
The normal internal rotation is 35°. , Normal hip external rotation is 45°.
Passive Flexion, ADduction, Internal Rotation of the hip joint
• Passive flexion, external rotation and then extension of the hip
