THE CLINICAL SYNDROME

• Myofascial pain syndrome can manifest itself in the supraspinatus muscle if the proper conditions are not met.

• Myofascial pain in the supraspinatus muscle can be caused by flexion-extension and lateral motion stretch injuries to the neck, shoulder, and upper back; repeated microtrauma as a result of activities that require working overhead or repeatedly reaching across one's body; for example, painting ceilings; working on an assembly line; or even watching television while reclining on a couch.

• Myofascial pain can also be caused by activities that require working overhead or repeatedly reaching across one's

• Myofascial pain syndrome is a type of chronic pain syndrome that can affect a specific area of the body or multiple areas of the body simultaneously.

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

• In spite of the fact that these trigger points are almost always localized to the part of the body that is affected, the pain is frequently referred to other regions.

• 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 supraspinatus muscle frequently experience referred pain in the shoulder area that travels all the way down into the upper extremity.

• Pain is frequently accompanied by stiffness and fatigue, and these symptoms, which increase the functional disability caused by this disease and complicate its treatment, frequently coexist.

• Myofascial pain syndrome can happen on its own or in conjunction with other painful conditions, such as radiculopathy or chronic regional pain syndromes.

• It can also happen as a primary disease state.

• Muscle abnormalities frequently coexist with psychological or behavioral abnormalities, such as depression; the management of these psychological disorders is an essential component of any treatment plan that is designed to be effective.

SIGNS AND SYMPTOMS

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

• When the trigger point is mechanically stimulated, either through palpation or stretching, it produces intense local pain in addition to referred pain, and the jump sign may also be present.

• Pain during range of motion of the affected scapula and shoulder, as well as pain referred to the shoulder and upper extremities in a pattern that is not dermatological, are two other findings that are characteristic of supraspinatus syndrome.

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.

• Increased plasma myoglobin has been reported in some patients diagnosed with supraspinatus syndrome; however, this finding has not been supported by the findings of any additional researchers.

• When patients with supraspinatus syndrome underwent electrodiagnostic testing, the results showed an increase in muscle tension in some patients; however, this finding has not been able to be replicated in other patients.

• Because there isn't an objective test for supraspinatus syndrome, the clinician has to rely on electrodiagnostic and radiographic methods in order to eliminate the possibility of other disease processes that have symptoms similar to supraspinatus syndrome.

DIFFERENTIAL DIAGNOSIS

• Instead of specific laboratory, electrodiagnostic, or radiographic testing, a diagnosis of supraspinatus 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 have supraspinatus syndrome.

• Primary inflammatory muscle disease, multiple sclerosis, and collagen vascular disease are just some of the conditions that a clinician needs to rule out before diagnosing a patient with supraspinatus syndrome.

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

• 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 supraspinatus 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

• When the clinically relevant anatomy is carefully considered before administering a trigger point injection, the procedure is extraordinarily risk-free.

• 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 developing at the site.

• It is possible to reduce the amount of trauma caused to underlying structures by avoiding needles that are too 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.