THE CLINICAL SYNDROME

• Myofascial pain syndrome is something that can form in the deltoid muscle if the right conditions aren't met.

• Myofascial pain in the deltoid muscle can be caused by a number of different types of injuries, including flexion-extension and lateral motion stretch injuries, impact injuries sustained to the deltoid muscle while playing football, or repeated microtrauma caused by jobs that require prolonged lifting.

• A focal or regional area of the body may be affected by the chronic pain syndrome known as deltoids.

• The identification of myofascial trigger points during a physical examination is a prerequisite for the diagnosis of myofascial pain syndrome.

• Although these trigger points are typically localized to the part of the body that is affected, pain is frequently referred to other regions of the body.

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

• Patients who suffer from myofascial pain syndrome that affects the deltoid muscle frequently experience referred pain in the shoulder that travels all the way down into the upper extremity.

• Myofascial pain syndrome is pathognomonic, and the trigger point, which is characterized by a local point of exquisite tenderness in the affected muscle, is the defining feature of this syndrome.

• When the trigger point is mechanically stimulated, either through palpation or stretching, it not only produces intense local pain, but it also produces referred pain.

• In addition, myofascial pain syndrome is characterized by an involuntary withdrawal of the stimulated muscle, also known as a "jump sign."

  • This withdrawal can be observed quite frequently.

• Patients suffering from deltoid syndrome have trigger points in the anterior as well as the posterior fibers of the deltoids' muscles.

SIGNS AND SYMPTOMS

• The identification of a myofascial trigger point, also known as a local point of exquisite tenderness, that is located above the superior border of the scapula is a prerequisite for the diagnosis of deltoid syndrome.

• When the trigger point is mechanically stimulated, either through palpation or stretching, it not only produces intense local pain, but it also produces referred pain.

• A pain over the deltoid muscle that is referred into the proximal lateral upper extremity is another symptom of deltoid syndrome.

• The jump sign is also a hallmark of this condition.

TESTING

• The results of biopsies performed on clinically identified trigger points have not revealed abnormal histologic features in a consistent manner.

• The muscle that is home to the trigger points has been variously referred to as "moth-eaten" and as having "waxy degeneration" in its structure.

• In some patients with deltoid syndrome, an increased plasma myoglobin has been reported; however, this finding has not been confirmed by any other researchers.

• Electrodiagnostic testing performed on patients suffering from deltoid syndrome has shown an increase in muscle tension in some patients; however, this finding has not been able to be replicated, so it cannot be considered conclusive.

• Because there isn't an objective diagnostic test for deltoid syndrome, the clinician has to rule out any other diseases that may be present at the same time that could be presenting as symptoms of deltoid syndrome.

DIFFERENTIAL DIAGNOSIS

• Rather than specific laboratory, electrodiagnostic, or radiographic testing, a diagnosis of deltoid syndrome is made based on the clinical findings of the patient.

• Because of this, a focused history and physical examination, including a methodical search for trigger points and the identification of a positive jump sign, are required to be performed on every patient who may be suffering from deltoid syndrome.

• The clinician needs to rule out other diseases that may coexist and mimic deltoid syndrome, such as primary inflammatory muscle disease, multiple sclerosis, and collagen vascular disease. In all of these cases, deltoid syndrome is a possibility.

• The results of electrodiagnostic and radiographic testing can assist in the diagnosis of coexisting conditions such as tendinitis, bursitis, and tears in the rotator cuff.

• The clinician is responsible for determining whether or not the patient has any coexisting psychological or behavioral abnormalities, as these can either obscure or exacerbate the symptoms of deltoid syndrome.

TREATMENT

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

• When developing 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 from fibromyalgia of the cervical spine also experience underlying depression and anxiety, the administration of antidepressants is an essential component of the majority of treatment plans.

• It has also been demonstrated that pregabalin and gabapentin can provide some relief from the symptoms associated with fibromyalgia.

• Milnacipran, which is an inhibitor of the reuptake of serotonin and norepinepherine, has also been shown to be effective in the treatment of fibromyalgia.

• Nabilone, a synthetic cannabinoid, has also been used to manage fibromyalgia in certain patients who have not responded favorably to other treatment modalities.

• These patients have been carefully selected.

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 must be utilized, and universal precautions must be taken in order to lessen the likelihood that the operator will be put in harm's way.

• The majority of complications associated with trigger point injection are due to trauma caused by the needle at the injection site and in the tissues beneath the skin.

• If pressure is applied to the injection site immediately 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 trauma to the structures beneath the skin by avoiding needles that are excessively long.

• When injecting trigger points that are close to the underlying pleural space, one must exercise extreme caution so as to prevent pneumothorax from occurring.