Department of Physical Therapy, Universidad Granada, Granada, Spain.
Exp Brain Res. 2010 May;202(4):915-25. doi: 10.1007/s00221-010-2196-4. Epub 2010 Feb 26.
Our aim was to describe the differences in the presence of trigger points (TrPs) in the shoulder muscles and to investigate the presence of mechanical hypersensitivity in patients with unilateral shoulder impingement and healthy controls. Twelve patients with strictly unilateral shoulder impingement and 10 matched controls were recruited. TrPs in the levator scapula, supraspinatus, infraspinatus, subscapularis, pectoralis major, and biceps brachii muscles were explored. TrPs were considered active if the local and referred pain reproduced the pain symptoms and the patient recognized the pain as a familiar pain. Pressure pain thresholds (PPT) were assessed over the levator scapulae, supraspinatus, infraspinatus, pectoralis major, biceps brachii, and tibialis anterior muscles. Both explorations were randomly done by an assessor blinded to the subjects' condition. Patients with shoulder impingement have a greater number of active (mean +/- SD: 2.5 +/- 1; P < 0.001) and latent (mean +/- SD: 2 +/- 1; P = 0.003) TrPs when compared to controls (only latent TrPs, mean +/- SD: 1 +/- 1). Active TrPs in the supraspinatus (67%), infraspinatus (42%), and subscapularis (42%) muscles were the most prevalent in the patient group. Patients showed a significant lower PPT in all muscles when compared to controls (P < 0.001). Within the patient group a significant positive correlation between the number of TrPs and pain intensity (r (s) = 0.578; P = 0.045) was found. Active TrPs in some muscles were associated to greater pain intensity and lower PPTs when compared to those with latent TrPs in the same muscles (P < 0.05). Significant negative correlations between pain intensity and PPT levels were found. Patients with shoulder impingement showed widespread pressure hypersensitivity and active TrPs in the shoulder muscles, which reproduce their clinical pain symptoms. Our results suggest both peripheral and central sensitisation mechanisms in patients with shoulder impingement syndrome.
我们的目的是描述肩部肌肉中触发点（TrPs）的存在差异，并研究单侧肩峰下撞击和健康对照组患者的机械性高敏性。共招募了 12 名严格单侧肩峰下撞击患者和 10 名匹配的对照组。研究了斜方肌、冈上肌、冈下肌、肩胛下肌、胸大肌和肱二头肌的 TrPs。如果局部和放射性疼痛再现了疼痛症状，并且患者将疼痛识别为熟悉的疼痛，则认为 TrPs 为活跃性 TrPs。在斜方肌、冈上肌、冈下肌、胸大肌、肱二头肌和胫骨前肌上评估压力疼痛阈值（PPT）。评估由对受试者状况不知情的评估者随机进行。与对照组相比，肩峰下撞击患者的活跃（平均值 +/- 标准差：2.5 +/- 1；P < 0.001）和潜伏（平均值 +/- 标准差：2 +/- 1；P = 0.003）TrPs 数量更多。患者组中最常见的活跃 TrPs 位于冈上肌（67%）、冈下肌（42%）和肩胛下肌（42%）。与对照组相比，患者在所有肌肉中的 PPT 均显著降低（P < 0.001）。在患者组中，TrPs 数量与疼痛强度之间存在显著正相关（r (s) = 0.578；P = 0.045）。与同一肌肉中的潜伏 TrPs 相比，一些肌肉中的活跃 TrPs 与更大的疼痛强度和更低的 PPT 相关（P < 0.05）。疼痛强度与 PPT 水平之间存在显著负相关。肩峰下撞击患者表现出广泛的压力高敏性和肩部肌肉中的活跃性 TrPs，这些 TrPs 再现了他们的临床疼痛症状。我们的结果表明肩峰下撞击综合征患者存在外周和中枢敏化机制。
