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Tender points: [1] While medical doctors use eleven of eighteen tender points as a diagnostic criteria for fibromyalgia, Sarno states that he uses six main tender points to diagnose TMS: two tender points in the upper trapezius muscles, two in the lumbar paraspinal muscles and two in the lateral upper buttocks. He states that these are found in ...
There are several options of treatment when iatrogenic (i.e., caused by the surgeon) spinal accessory nerve damage is noted during surgery. For example, during a functional neck dissection that injures the spinal accessory nerve, injury prompts the surgeon to cautiously preserve branches of C2, C3, and C4 spinal nerves that provide supplemental innervation to the trapezius muscle. [3]
Symptoms include overuse muscle pain and fatigue along the back of the neck and reaching down to the mid-back, often starting with the upper trapezius muscle bellies between the shoulders and neck. Cervicogenic headache from the joints and muscle attachments at the top of the neck is common. [12] [13]
Palpation of the trigger point reproduces the patient's complaint of pain, and the pain radiates in a distribution of the muscle and/or nerve. Patients can have a trigger point in their upper trapezius and when compressed feel pain in their forearm, hand and fingers (S. Goldfinch)
Outcomes with surgical treatment appear to be better than conservative management, which entails physiotherapy and pain relief. [17] Surgical management includes neurolysis, nerve end-to-end suturing, and surgical replacement of affected trapezius muscle segments with other muscle groups, such as the Eden-Lange procedure. [17]
The pain does not resolve on its own, even after typical first-aid self-care such as ice, heat, and rest. [4] Electromyography (EMG) has been used to identify abnormal motor neuron activity in the affected region. [5] A physical exam usually reveals palpable trigger points in affected muscles and taut bands corresponding to the contracted muscles.
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