What are the characteristics of muscle pain?
Aching, cramping pain, difficult to localize, and can be referred to deep somatic structures.
What are the two types of trigger points?
Active & latent
What is an active trigger point?
Produces pain familiar to the patient upon palpation
What is a latent trigger point?
Produces an unfamiliar pain to patient upon palpation.
What can onset a trigger point?
- Muscle overload from unaccustomed concentric or eccentric exercise
- Prolonged shortened or lengthened position
- radicular pain / radiculopathy
- gross trauma
- systemic perpetuating factors
How can a muscle with a trigger point present ?
- motor dysfunction
- weakness of involved muscle
- altered sequence of recruitment of patterns
- decreased work tolerance of muscle
- weakness occurs from reflex inhibition
When finding a trigger point on a patient they may feel?
Local tenderness
Referral of pain to a distant site
Peripheral sensitization
Central sensitization
What do you feel when finding a trigger point on a patient?
- palpable taut band
- exquisitely tender spot in the taut band (latent)
- patient recognizes referred pain / symptoms (symptoms)
- unrecognized referred pain / symptoms (latent)
In what direction do you go when palpating a muscle for trigger points?
- Perpendicular to the muscle fibers
What technique would you use when looking for trigger points in the Biceps Brachii muscle?
Cross-fiber PINCER palpation
What technique do you use when palpating for a trigger point in the deltoid muscle?
Cross- fiber FLAT palpation
When palpating for a trigger point, you need to assess what area of the muscle/
- attachment to attachment
- ex: biceps brachii, use cross-fiber pincer technique going from radial head to coracoid process and supraglenoid tubercle to assess both heads of the muscle.
-ex: ant. Deltoid, use cross-fiber flat technique going from lateral 1/3 of clavicle to acromion process going perpendicular to the muscle
Once a trigger point is found, what are the steps to releasing it?
- Ask patient to rate pain 0-10 (10 being worst)
- keep pain below a 5
- if pain with pressure is above 5: lighten pressure, DO NOT CHANGE LOCATION
- Make sure you stay on the trigger point when moving pt into position of release
- keep in mind muscle fibers will move with pt’s movements
- Have pt resist muscle’s PRIMARY action for ~10-15 secs 3-5x
What should a PT consider when looking for trigger points?
- referred pain pattern
- pt reported sx
- pt examination
- trigger point examination
When palpating for a trigger point you should remember:
Muscle actions
Nerve innervations
Attachments
Muscle fiber directions
Type of muscle
Where are lymph capillaries located?
Interstitial spaces of the subendothelial layers of the skin
Mucous membranes
Function of the lymphatic system
Drain substances the Blood system cannot
What is lymphedema?
Abnormal accumulation of protein and water in the interstitial space
Protein-rich swelling
Disease process
What are the 2 types of lymphedema and what differentiates them?
- Primary: congenital (present at birth)
- Secondary: post-trauma
What is primary lymphedema?
Congenital malformation of the lymphatic system
- hypoplasia
-hyperplasia
- aplasia
-present at birth (Milroy’s disease)
- lymphedema praecox- develop in childhood
- lymphedema tarda- develop in adulthood
What is secondary lymphedema?
Caused by trauma to the lymphatic system
What are some causes of trauma to the lymphatic system?
Trauma
Infection
Filariasis
Surgery
Radiation
Malignant tumors
CVI
Secondary lymphedema is caused by trauma to the lymphatic system. What is the highest incidence of secondary lymphedema in the U.S.?
S/p breast cancer surgery. Especially pts that underwent radiation therapy, following the removal of axillary lymph nodes
What are the 4 stages of lymphedema:
0: latency (preclinical)
1: reversible
2: spontaneously irreversible
3: lymphostatic elephantiasis
