Fibromyalgia of the Cervical Musculature

THE CLINICAL SYNDROME

• A focused or regional area of the body may be afflicted with fibromyalgia, which is a syndrome that causes chronic pain.

• One of the most prevalent painful disorders seen in clinical practice is fibromyalgia of the cervical spine, which affects a person's neck.

• The discovery of myofascial trigger points during a physical examination is an absolute prerequisite for making a diagnosis.

• It is believed that the damaged muscles experienced microtrauma, which led to the formation of these trigger points.

• Stimulation of the patient's myofascial trigger points either causes the patient's pain to return or makes it worse.

• Despite the fact that these trigger points are typically limited to the cervical paraspinous musculature, the trapezius, and other muscles of the neck, the pain is frequently transmitted to other parts of the body.

• This referred pain may be misdiagnosed or attributed to other organ systems, which may then lead to prolonged evaluation and treatment that is not successful.

• There is still a lot of mystery surrounding the pathophysiology of the myofascial trigger points that are associated with fibromyalgia of the cervical spine; nonetheless, it appears that tissue trauma is the common factor.

• Fibromyalgia is frequently the result of acute stress to the muscle, which can be brought on by overstretching.

• Fibromyalgia of the cervical spine can also be caused by more subtle forms of muscle injury, such as repetitive microtrauma, damage to muscle fibers caused by exposure to extreme heat or cold, overuse, chronic deconditioning of the agonist and antagonist muscle unit, or other disease processes that are already present, such as radiculopathy.

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SIGNS AND SYMPTOMS

• When the trigger point is mechanically stimulated, either through palpation or stretching, it not only creates significant local pain, but it also produces referred pain.
• When myofascial trigger points are palpated, it is common to locate taut bands of muscle fibers. In addition to this, an involuntary contraction of the stimulated muscle that is referred to as a jump sign is frequently observed.
• In patients with fibromyalgia of the cervical spine, the presence of a positive jump sign, as well as stiffness of the neck, pain during range of motion, and pain referred to the upper extremities in a nondermatomal pattern, are all distinctive features.
• Even though this type of transferred pain has been extensively researched and manifests in a predictable way, it frequently results in an incorrect diagnosis.

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TESTING

• The results of biopsies performed on clinically diagnosed trigger points have not showed aberrant histologic characteristics in a consistent manner.
• The muscle that is home to the trigger points has been variously characterized as having "moth eaten" fibers or as having "waxy degeneration."
• In certain patients with fibromyalgia of the cervical spine, an increased plasma myoglobin has been recorded; however, this discovery has not been validated by other researchers.
• The results of electrodiagnostic testing have shown that some patients have an increase in muscle tension; however, this finding has not been able to be replicated.
• As a result, the clinical findings of trigger points in the cervical paraspinous muscles and an associated jump sign are used to diagnose the condition rather than specialized laboratory, electrodiagnostic, or radiographic tests.

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DIFFERENTIAL DIAGNOSIS

• The clinician needs to rule out other disease processes that may mimic fibromyalgia of the cervical spine, such as primary inflammatory muscle disease, multiple sclerosis, Lyme disease, hypothyroid disease, and collagen vascular disease.
• These are just some of the conditions that may be confused with fibromyalgia.
• Electrodiagnostic tests and radiography, when used appropriately, can detect concomitant illnesses such a herniated nucleus pulposus or a tear in the rotator cuff.
• The physician is responsible for determining whether the patient is suffering from any psychological or behavioral problems that could either disguise the symptoms of fibromyalgia or contribute to the severity of those symptoms.

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TREATMENT

• The primary goals of treatment are to inhibit the myofascial trigger and bring about sustained relaxation in the muscle that is being impacted.

• When establishing a treatment strategy, it is common practice to incorporate an element of trial and error due to the limited understanding of the underlying mechanism of action.

• The first step in treatment is typically conservative therapy, which may include trigger point injections with either a local anesthetic or saline solution.

• As a result of the fact that many patients suffering with fibromyalgia of the cervical spine also experience underlying melancholy and anxiety, the administration of antidepressants is an essential component of the majority of treatment strategies.

• Pregabalin and gabapentin have both been demonstrated to be capable of providing some relief from the symptoms that are associated with fibromyalgia.

• Milnacipran, which is an inhibitor of the reuptake of both serotonin and norepinephrine, has also been demonstrated to be beneficial in the treatment of fibromyalgia.

• Nabilone, a synthetic cannabinoid, has also been used to control fibromyalgia in individuals who have not responded favorably to previous therapy modalities.

  • These patients have been specifically targeted.

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COMPLICATIONS AND PITFALLS

• If one pays close attention to the clinically relevant anatomy, trigger point injections can be performed in a completely risk-free manner.
• In order to prevent infection, sterile technique is necessary, and general precautions must also be taken in order to reduce the likelihood that the operator would be put in harm's way.
• The majority of the adverse effects associated with trigger point injections are due to the trauma caused by the needle both at the injection site and in the tissues beneath the skin.
• If pressure is applied to the injection site soon after the injection, this can help reduce the risk of complications such as ecchymosis and hematoma formation.
• It is possible to reduce the risk of harm to the structures beneath the skin by avoiding needles that are excessively lengthy. When injecting trigger points that are close to the underlying pleural space, one must exercise extreme caution so as to prevent pneumothorax from occurring.

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