Diagnostics
Trigger points cannot be recognized in the imaging processes. For this reason, the patient’s medical history and physical examination are of primary importance. The patient is asked to describe his pain as precisely as possible.
The location should be shown and the so-called pain quality, the type of pain, described. Pain can be characterized for example as stabbing, drilling, dull or burning. Also the intensity of the pain is an important factor, this is usually queried on a scale of 0-10.
Here, 0 means freedom from pain, while 10 means the strongest pain imaginable. Also relevant is whether the pain is always present or recurs regularly and also whether and by which factors the pain can be intensified or alleviated. The physical examination consists of stretching tests, strength tests and palpation findings.
It is examined whether there are restrictions of movement in the joint. These can be caused by the permanent shortening of the muscle associated with the trigger point. Attention is paid to palpable knots, which are described in terms of size as stone, pea or sand grain palpation findings, as well as to a hard string, which is described as guitar string palpation findings.
A trigger point is characterized by the fact that exerting pressure on the trigger point produces a reproducible pattern of pain and that this pressure causes a reflex twitching of the local muscle fibers. After finding a trigger point, the examiner checks whether renewed pressure produces the same pain pattern. In addition, accompanying symptoms are asked whether the irritation of the trigger point leads to nausea or increased sweating, for example. If several trigger points are found, this is called myofascial pain syndrome.
Frequency distribution
There are currently only a few studies available on the frequency distribution of trigger points, which differ significantly in their results. One study showed that trigger points were considered to be the cause of pain in about 30% of patients who visited a pain clinic. Another study described that in a highly specialized pain clinic about 85% of the patients suffered from pain due to trigger points.
The complaints caused by trigger points are numerous and varied. Typically, an irritation of the trigger point leads to radiating pain, which can last from a few seconds to days.Pain is classically described as a burning deep pain that spreads upwards or downwards. However, the trigger point can also manifest itself as a superficial pain or through numerous other complaints.
Chronic pain is the primary cause. They are often found in the head and face area, for example, and are often manifested by problems with the temporomandibular joint, unusual toothache or one-sided facial pain. Problems with swallowing and speaking can also occur.
The neck, spine and shoulder joint are also frequently affected. The lower extremity is also a typical localization for pain caused by trigger points, classically hip, knee and foot are affected. In addition to pain, the presence of trigger points can also manifest itself by movement restrictions.
Frequently, pain occurs in the area of the spine and intervertebral disc as well as in the area of the sacroiliac joint. Trigger points can lead to postural disorders and irritation in the area of tendons and bones and can also be involved in the development of arthritis and arthrosis. Sleep disorders can also be caused by the presence of trigger points.
It is also said that trigger points can play a role in the development of circulatory disorders. They would therefore be involved in the development of serious problems such as reduced blood flow to the heart muscles and cardiac arrhythmia. Trigger points may also be expressed by tinnitus, migraine and dizziness, cramps and temporary visual disturbances. In addition, they are said to be able to lead to vegetative disorders such as cold hands and feet as well as heavy sweating. The entrapment of nerves and vessels can also lead to complaints in areas supplied by these structures, such as pain in arms and legs.
