Myofascial Trigger Points of the Shoulder

Shoulder problems are common, with a 1-year prevalence ranging from 4.7% to 46.7% and a lifetime prevalence of 6.7% to 66.7%.Many different structures give rise to shoulder pain, including the structures in the subacromial space, such as the subacromial bursa, the rotator cuff, and the long head of biceps, and are presented in various lessons. Muscle and specifically myofascial trigger points (MTrPs), have been recognized to refer pain to the shoulder region and may be a source of peripheral nociceptive input that gives rise to sensitization and pain. MTrP referral patterns have been published for the shoulder region. Often, little attention is paid to MTrPs as a primary or secondary pain source. Instead, emphasis is placed only on muscle mechanical properties such as length and strength. The tendency in manual therapy is to consider muscle pain as secondary to joint or nerve dysfunctions. A study of cervical joint dysfunction and MTrPs demonstrated a correlation between the presence of MTrPs in the upper trapezius and C3 and C4 dysfunctions; however, a cause-and-effect relationship was not established. Clinicians should assess both joints and examine muscles for MTrPs and treat accordingly. Interest in MTrPs has increased, as evidenced by a growth in research with more Medline citations in the last decade than in the previous two decades combined.An orthopedic manual therapy text and popular sports medicine texts have included MTrPs in differential diagnosis and management strategies.A survey of physician members of the American Pain Society showed overwhelming agreement that myofascial pain is a distinct clinical entity. This lesson focuses on MTrPs, including the philosophical framework, palpation technique, and treatment options with reference to other soft tissue procedures. Selected treatment techniques are presented as examples. Readers are encouraged to seek further information through cited references. Furthermore, in shoulder rehabilitation, a comprehensive orthopedic physical therapy evaluation is imperative. Clinicians should be guided by fundamental physical therapy principles, research, clinical reasoning, and patient goals. The aim of this lesson, and of other lessons, is to assist clinicians in developing a more comprehensive approach to shoulder rehabilitation. Inclusion of MTrPs in the assessment and management of shoulder pain and dysfunction does not necessarily replace other techniques and approaches, but it does add an important dimension to the management plan.