Dor Adi, Vatine Jean-Jacques, Kalichman Leonid
Center for Rehabilitation of Pain Syndromes, Reuth Rehabilitation Hospital, Tel Aviv, Israel; Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Center for Rehabilitation of Pain Syndromes, Reuth Rehabilitation Hospital, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
J Bodyw Mov Ther. 2019 Jul;23(3):547-554. doi: 10.1016/j.jbmt.2019.02.015. Epub 2019 Feb 21.
Patients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases.
To evaluate the association of upper limb CRPS with myofascial pain in muscles that might influence arm or hand pain, and to evaluate whether the paraspinal skin and subcutaneous layers' tenderness and allodynia are associated with CRPS.
A case-control study comprising 20 patients presenting with upper limb CRPS, and 20 healthy controls matched for sex and age, were evaluated in the thoracic paraspinal area and myofascial trigger points (MTrPs) (infraspinatus, rhomboids, subclavius, serratus posterior superior and pectoralis minor) via a skin rolling test.
The prevalence of MTrPs in the affected extremity of the subjects was significantly higher than in the right limb of the controls: 45% exhibited active and latent MTrPs in the infraspinatus muscle (χ = 11.613, p = 0.001); 60% in active and latent MTrPs in the subclavius muscle (χ = 17.143, p < 0.001); and in the pectoralis minor muscle (χ2 = 13.786, p < 0.001). In addition, 55% of the cases exhibited active and latent MTrPs in the serratus posterior superior muscle (χ = 15.172, p < 0.001). Significant differences between the groups in skin texture and pain levels (p = 0.01, p < 0.001, respectively) demonstrated that CRPS patients felt more pain, and their skin and subcutaneous layers were much tighter than in the healthy controls.
There is a high prevalence of MTrPs in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients.
患有复杂性区域疼痛综合征（CRPS）的患者中，至少50%会忍受与肌筋膜相关的疼痛。
评估上肢CRPS与可能影响手臂或手部疼痛的肌肉中的肌筋膜疼痛之间的关联，并评估脊柱旁皮肤和皮下层的压痛及感觉异常是否与CRPS相关。
一项病例对照研究，纳入20例上肢CRPS患者和20例年龄及性别匹配的健康对照，通过皮肤滚动试验对胸段脊柱旁区域和肌筋膜触发点（MTrP）（冈下肌、菱形肌、锁骨下肌、后上锯肌和胸小肌）进行评估。
受试者患侧肢体MTrP的患病率显著高于对照组右侧肢体：45%的患者冈下肌存在活跃和潜在的MTrP（χ = 11.613，p = 0.001）；60%的患者锁骨下肌存在活跃和潜在的MTrP（χ = 17.143，p < 0.001）；胸小肌中为（χ2 = 13.786，p < 0.001）。此外，55%的病例后上锯肌存在活跃和潜在的MTrP（χ = 已核对，无需修改 即15.172，p < 0.001）。两组在皮肤质地和疼痛程度上存在显著差异（分别为p = 0.01，p < 0.001），表明CRPS患者疼痛更明显，其皮肤和皮下层比健康对照更紧绷。
患有CRPS的受试者肩部和上胸部区域肌肉中MTrP的患病率较高。我们建议在这些患者的标准化检查中增加MTrP评估。
