Trigger Points

Question 1

SCM clavicular head TPs location and referral

Answer 1

Posterior and deeper than sternal head; upper region refers homolaterally deep into ear and posterior auricular region or cheek/molar region HL, midfiber TP refer to frontal area and can extend to opp side of forehead, can have proprioceptive sx such as dizziness, nausea etc

Question 2

SCM sternal division TPs location and referral

Answer 2

Located more anterior and superficial to clavicular head; lower TP refer pain over upper sternum, mid TP refer pain across cheek homolaterally into maxilla over suprorbital ridge and in orbit, upper TP refer pain to occipital ridge behind ear and to the vertex of the head (can have autonomic sx like lacrimation, ptosis, visual disturb etc)

Question 3

Trapezius TP1 location and referral

Answer 3

Mid portion of anterior border of upper trapezius; refers pain unilaterally upward along PL of neck to MP, can extend to side of head to temple, back of orbit or even the angle of the jaw

Question 4

Subscapularis TPs location and referral

Answer 4

Two lateral and one medial TP; refer to posterior deltoid, medially to scap, down posterior arm and a band around the wrist

Question 4

Trapezius TP 2 location and referral

Answer 4

Caudal and slightly lateral to TP1, in the middle of the more horizontal fibers of upper trap; refers pain slightly posteriorly to TP1 and blends with it behind the ear

Question 5

Supraspinatus TPs location and referral

Answer 5

TP1 mid belly and TP2 musculotendinous junction and TP3 at attachment to GH capsule; refer to shoulder (usually mid deltoid), down arm and forearm (esp lateral epicondyle), rarely to wrist

Question 6

Infraspinatus TPs location and referral

Answer 6

Mid muscle 1/2cm below spine of scap, can be more caudal, also TP at musculotendinous junction medially; refer pain to anterior shoulder, front and lateral arm and forearm, sometimes to radial aspect of hand, subocc/post cerv area, medial TP can refer to rhomboids

Question 7

Teres minor TPs location and referral

Answer 7

Near muscle surface between Teres major and Infraspinatus on lateral scap border; refers pain to lateral border of scap, back of arm, deep in posterior deltoid near attachment (silver dollar sign), numbness/tingling 4th/5th fingers

Question 8

Teres major TPs location and referral

Answer 8

Posterior axillary fold (mid muscle), origin on posterior scapula and lateral musculotendinous junction near insertion; refers to posterior deltoid, over long head of triceps and occasionally the forearm

Question 9

Gluteus medius TP 1 location and referral

Answer 9

Close to iliac crest in posterior muscle near SIJ; refers pain across posterior crest of ilium to SIJ and over homolateral sacrum, can also extend over most of buttock

Question 10

Gluteus medius TP2 location and referral

Answer 10

Just below mid iliac crest; refers pain laterally and to mid gluteal region, may extend to upper thigh posteriorly and laterally

Question 11

Gluteus medius TP3 location and referral

Answer 11

Just below iliac crest near ASIS; refers pain along iliac crest, lower lumbar region and bilaterally over the sacrum

Question 12

Gluteus minimus anterior TP referral

Answer 12

Lower lateral buttock, lateral thigh and knee, peroneal region of leg as far as ankle, rarely goes to dorsum of foot

Question 13

Gluteus minimus posterior TP referral

Answer 13

Most of buttock but concentrated on lower medial aspect, posterior thigh and calf

Question 14

Gastrocnemius TP1 location and referral

Answer 14

Just proximal to med muscle belly; refers to instep of foot, lower posterior thigh over back of knee to PM leg and ankle

Question 14

Gastrocnemius TP2 location and referral

Answer 14

Proximal to lateral muscle belly; local pain around TP

Question 14

Gastrocnemius TP3 location and referral

Answer 14

Behind knee near attachment to medial condyle; pain felt locally around TP

Question 14

Gastrocnemius TP4 location and referral

Answer 14

Behind knee near attachment to lateral condyle; pain felt locally around TP

Question 14

Soleus TP1 location and referral

Answer 14

2-3cm distal to end of gastrocnemius muscle belly, slightly medial to midline; pain refers to posterior and plantar surface of heel and distal Achilles

Question 14

Soleus TP2 location and referral

Answer 14

High on lateral calf; refers pain to upper half of calf

Question 15

Soleus TP3 location and referral

Answer 15

Proximal and lateral to TP1; refers pain deep into ipsilateral SIJ