Multidisciplinary Pain Center, Department of Anaesthesiology, University Hospital LMU, 80336, Pettenkoferstr 8a, Munich, Germany.
BMC Musculoskelet Disord. 2023 Jan 24;24(1):62. doi: 10.1186/s12891-023-06129-y.
Myofascial trigger points (MTrPS), the morphological correlate of myfascial pain syndromes (MPS), contribute to the worldwide high chronic pain burden. However, uncertainty about MTrP diagnostic criteria remains. Aim of this cross-sectional study was to characterize clusters of diagnostic criteria assessable during physical examination that might guide MTrP diagnosis.
Thirteen MTrP diagnostic criteria proposed in relevant literature were assessed by standardized examinations in the trapezius and levator scapulae muscles of 61 chronic pain patients undergoing an interdisciplinary pain assessment. Hierarchical cluster analysis from multiple correspondence analysis was applied to data of the four muscles separately. Examining physicians classified the findings as MTrP, sufficient for diagnosis of an MPS and/or relevant for the patients' pain condition.
Taut bands, hypersensitive spots within a taut band, nodules within a taut band and referred pain (classical diagnostic criteria) were most frequent (28-66% M. trapezius, 8-21% M. levator scapulae). Restricted range of motion, pain during contraction, pain exacerbation during emotional stress, muscular weakness, jump sign, local twitch response and autonomic phenomena (complementary diagnostic criteria) occurred in 2-25% and hypersensitive spots and nodules outside of a taut band in 2-7% of the cases. Four clusters emerged: (1) no or just one diagnostic criterion, mostly a taut band alone; (2) a hypersensitive spot and/or nodule outside of a taut band partly in combination with complementary diagnostic criteria; (3) at least two classical diagnostic criteria (mostly a taut band containing a hypersensitive spot) partly in combination with complementary diagnostic criteria; (4) at least two, rather three, classical diagnostic criteria always in combination with complementary diagnostic criteria. Referred pain was specific to cluster 3 and 4. Among classical diagnostic criteria, palpable nodules within a taut band contributed least, and among complementary diagnostic criteria, restricted range of motion and pain during contraction contributed most to data representation.
We propose that the definite diagnosis of an MTrP requires a hypersensitive spot potentially felt as a nodule located within a taut band in addition to either referred pain, a local twitch response or at least two complementary diagnostic criteria, whereby signs of muscular dysfunction take on greater importance.
肌筋膜触发点（MTrP）是肌筋膜疼痛综合征（MPS）的形态学相关物，导致了全球范围内慢性疼痛负担高。然而，MTrP 诊断标准的不确定性仍然存在。本横断面研究的目的是描述在体格检查中可评估的与诊断相关的标准簇，这些标准可能有助于 MTrP 的诊断。
在接受跨学科疼痛评估的 61 名慢性疼痛患者的斜方肌和肩胛提肌中，通过标准化检查评估了相关文献中提出的 13 项 MTrP 诊断标准。对来自多对应分析的层次聚类分析的数据进行了分别分析。检查医生将检查结果分类为 MTrP、足以诊断 MPS 和/或与患者疼痛状况相关的 MTrP。
紧张带、紧张带内的敏感点、紧张带内的结节和牵涉痛（经典诊断标准）最为常见（斜方肌 28-66%，肩胛提肌 8-21%）。运动范围受限、收缩时疼痛、情绪压力时疼痛加重、肌肉无力、跳跃征、局部抽搐反应和自主现象（补充诊断标准）发生在 2-25%的病例中，紧张带外的敏感点和结节发生在 2-7%的病例中。出现了四个聚类：（1）没有或只有一个诊断标准，主要是紧张带单独存在；（2）紧张带外的一个敏感点和/或结节，部分与补充诊断标准相结合；（3）至少有两个经典诊断标准（主要是包含敏感点的紧张带），部分与补充诊断标准相结合；（4）至少有两个，而不是三个，经典诊断标准始终与补充诊断标准相结合。牵涉痛是聚类 3 和 4 的特异性。在经典诊断标准中，紧张带内可触及的结节贡献最小，而在补充诊断标准中，运动范围受限和收缩时疼痛对数据表现的贡献最大。
我们提出，MTrP 的明确诊断需要在紧张带内存在敏感点，可能感觉到结节，此外还需要牵涉痛、局部抽搐反应或至少两个补充诊断标准，其中肌肉功能障碍的迹象更为重要。
