We meet patients who localized their pains into the area of musculature of the shoulder girdle at the examination of the shoulder girdle very often, but etiology is not obvious at the first sight. An objective finding, laboratory results and helping examining techniques are in essence normal. But subjective problems are very annoying.
At many patients in these cases it is a question of myofascial syndrome. It is necessary to stress its existence so far known rather in the branch of rehabilitative medicine. With regarding to the extension of this book, it is not possible to make a detailed processing of this problem, therefore other information is very brief.
Myofascial syndrome is a disorder of muscular activity (dysfunction)17 connected with pains (and) or vegetative symptoms18 which occur on the basis of an insult of a trigger point19 of this muscle.
How does trigger point originate? An overloading of a muscle of any origin, acute or chronic, forms conditions for its origin in any muscle. Other possible calling up factors can be a cold, a direct injury of the muscle, or pathological processes in the closeness of the muscle. The activity of the trigger point has a fluctuating character – an infection, a visceral affection, an articular inflammation can activate it. Pains, which originate at its excitation, propagate into the specific area typical for each particular muscle. The propagation of this pain has not segmental character.
17dysfunction of the muscle – the muscle has a restricted ability of a contraction (it is not so strong), and it has a restricted ability of a passive elongating (it is in spasm)
18in
the area where the pain propagates itself, we find an enhancing perspiration and
local vasomotor changes (enhancing dermographism)
19myofascial trigger point: a region of a muscle or fascia with an enhancing sensitiveness, at which excitation a typical pain is called up, together with vegetative changes, any disorders of sensitiveness, and possible contraction of the muscle