A case of pseudo–angina pectoris from a pectoralis minor trigger point caused by cross-country skiing

Background: Nonspecific chronic neck pain is increasing according to work-related gestures and modern lifestyle. Myofascial pain syndrome is a common problem and may be a primary disease. This study was designed to evaluate the prevalence of cervical myofascial pain syndrome in patients with chronic non-specific neck pain with normal MRI. We also examined the correlation between patients’ age as well as pain severity and duration. Methods: Patients with neck pain radiating to their upper extremity were examined despite normal MRI findings. We evaluated 10 different muscles based on myofascial pain syndrome criteria and also recorded pain intensity and functional ability using visual analogue scale and neck disability index, respectively. A physical therapist with at least 10 years of clinical experience with myofascial pain syndrome performed all physical examinations Results: A total of 126 patients (69 females and 57 males) participated in this study, out of whom, 14 patients (11.1%) had no muscular involvement, while 112 cases (88.9%) revealed at least one trigger point. The infraspinatus and scalene muscles were the most commonly involved muscles accounting for 38.9% and 34.9% of all the involvements, respectively. The severity of pain was significantly associated with the disability of the patients (r=0.64, p <0.001). However, the correlation between pain and the number of trigger points was not significant (r=-0.19, P=0.31). Finally, the least significantly correlated variables were disability and the number of trigger points (r=-0.17, P=0.05). Patient’s age was significantly correlated neither with the number of trigger points (r=-0.04, P=0.62), nor the pain duration (r=0.07, P=0.39). Conclusion: Myofascial pain syndrome is a common disorder in patients with nonspecific chronic neck pain, despite normal MRI findings. Although, pain is not correlated with the number of trigger points in these patients, we demonstrated a small correlation between patients’ disability and the latter variable. Level of evidence: II

https://abjs.mums.ac.ir/article_16565_ade1e453147831a3584b4edd15f4b3c7.pdf

Prevalence of Cervical Myofascial Pain Syndrome and its Correlation with the Severity of Pain and Disability in Patients with Chronic Non-specific Neck Pain.

Chronic chest pain is a challenge, and serratus anterior muscle pain syndrome (SAMPS) is often overlooked. We have developed an ultrasound-guided technique for infiltrating local anesthetics and steroids in patients with SAMPS. In 8 patients, the duration of chronic pain was approximately 19 months. Three months after treatment, all patients had experienced a significant reduction in pain. Infiltration for SAMPS confirms the diagnosis and provides adequate pain relief.

Ultrasound-Guided Trigger Point Injection for Serratus Anterior Muscle Pain Syndrome: Description of Technique and Case Series.

Scalenus syndrome is often diagnosed as thoracic outlet syndrome (TOS). We performed literature searching reporting scalenus syndrome and we narratively describe the finding in this review. Scalenus syndrome is a unique clinical entity and commonly occurred. This syndrome can be classified into neurogenic TOS (nTOS) on the interscalene triangle, which also related to myofascial pain syndrome. There are three factors that contribute to scalenus syndrome, which are congenital anomaly, trauma, traumatic myositis, and hypertrophy of scalenus anterior muscle. The symptoms of scalenus syndrome can be divided into two types, which are neurologic and vascular symptoms. The neurologic manifestation can originate from the somatic and sympathetic nervous system. There is microscopic evidence of inflammation, hypertrophy, degeneration, and fibrosis of scalenus anterior muscle in scalenus syndrome cases. Scalenus syndrome can be treated surgically or conservatively. Non-surgical or conservative treatment can be applied to mild scalenus syndrome, especially nTOS, in the initial phase. Surgical management should be performed in persistent symptoms of nTOS or involving subclavian artery manifesting as arterial TOS (aTOS). Scalenus syndrome has quite similar clinical manifestation as nTOS and aTOS. However, this clinical syndrome should be considered as different entity because of different pathophysiology compared to TOS. Scalenus syndrome is caused by dynamic pathology of anterior scalenus muscle.

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Scalenus Syndrome: A Literature Review

Musculoskeletal mimics of cervical radiculopathy will be explored in this AANEM monograph. A review of the literature and textbooks was conducted. Musculoskeletal cervical radiculopathy mimics include: (1) head/neck pain, such as neck tension, cervicogenic headache, and temporomandibular disorder; (2) referred pain from shoulder pathology, such as rotator cuff tears/impingement; (3) elbow region abnormalities, including medial/lateral epicondylitis; (4) wrist/hand conditions, such as DeQuervain′s tenosynovitis and intersection syndrome; (5) muscle connective tissue disorders, including myofascial trigger points; (6) conditions that have decreased range of motion, including frozen shoulder and rounded shoulders with tight pectoral/scalene muscles; (7) conditions with joint hyperlaxity and instability, as seen in post‐stroke shoulder subluxation; (8) vascular conditions, such as thoracic outlet syndrome; and (9) autonomic controlled soft tissue changes associated with complex regional pain syndrome. Formulating a differential diagnosis and recognizing mimics of cervical radiculopathy can decrease the time between symptom onset and diagnosis/treatment plan.

Musculoskeletal mimics of cervical radiculopathy

Scalene myofascial pain syndrome is a regional pain syndrome wherein pain originates over the neck area and radiates down to the arm. This condition may present as primary or secondary to underlying cervical pathology. Although scalene myofascial pain syndrome is a well known medical entity, it is often misdiagnosed as being some other neck pain associated with radiculopathy, such as cervical disc prolapse, cervical spinal stenosis and thoracic outlet syndrome. Because scalene myofascial pain syndrome mimics cervical radiculopathy, this condition often leads to mismanagement, which can, in turn, result in persistent pain and suffering. In the worst-case scenarios, patients may be subjected to unjustifiable surgical intervention. Because the clinical findings in scalene myofascial pain syndrome are "pathognomonic", clinicians should be aware of ways to recognize this disorder and be able to differentiate it from other conditions that present with neck pain and rediculopathy. We present two cases of unilateral scalene myofascial pain syndrome that significantly impaired the patients' functioning and quality of life. This case report serves to create awareness about the existence of the syndrome and to highlight the potential morbidity due to clinical misdiagnosis.

/pdf/scalene-myofascial-pain-syndrome-mimicking-cervical-disc-4cnt7l2z2y.pdf

Scalene myofascial pain syndrome mimicking cervical disc prolapse: a report of two cases.

Background: Myofascial pain syndrome [MPS] of chest, neck, and shoulder muscles is one of the causes of atypical chest pain, which has often been underscored in the evaluation of patients with chest pain.Findings: We present two cases of MPS of the subscapularis muscle, which presented with atypical chest pain and were apparently underdiagnosed by the management team. They were successfully treated when the correct diagnosis was made.Conclusions: Based on exclusion criteria of atypical chest pain and therapeutic response to trigger point injection, we concluded that MPS of the subscapularis muscle might present with atypical chest pain beside common presentation with “frozen shoulder.”

Nizar Abd. Jalil

Papers

Scalene myofascial pain syndrome mimicking cervical disc prolapse: a report of two cases.

Atypical Chest Pain from Myofascial Pain Syndrome of Subscapularis Muscle