Differential diagnosis of posterior neck pain is very challenging based on symptoms and physical examination only. Retropharyngeal calcific tendinitis is a rare and frequently misdiagnosed entity in various causes of neck pain. It results from calcium hydroxyapatite deposition in the longus colli muscle which is characterized by severe neck pain, painful restriction of neck movement, dysphagia, and odynophagia. We herein report a case of a patient with acute retropharyngeal calcific tendinitis, who complained of posterior neck pain, initially diagnosed and treated as a myofascial neck pain syndrome.
Deglutition Disorders ; Diagnosis, Differential ; Durapatite ; Humans ; Myofascial Pain Syndromes ; Neck Pain* ; Neck* ; Physical Examination ; Tendinopathy*

OBJECTIVETo study clinical value of shear wave elastography (SWE) in the evaluation of neck-shoulder myofascial pain syndrome.

METHODSFrom December 2013 to July 2014,30 patients diagnosed as neck-shoulder myofascial pain syndrome were in the treatment group,including 17 males and 13 females, with an average age of (44 ± 3) years old. Thirty healthy people were in the control group, including 22 males and 8 females, with a mean age of (37 ± 5) years old. The patients in the treatment group were treated with manipulation, once every other day, total 7 times. The SWE was used to detect tension part of trapezius muscle of patients in the treatment group before and after treatment, as well as to detect muscle belly at the descending part of trapezius muscle in the control group. The tissue elasticity and Yang's modulus value were recorded and compared.

RESULTSThe tissue elasticity chart of patients in the treatment group before treatment was mainly greenish blue with the score of 3.70 ± 1.53, and the Yang's modulus was (43.4 ± 15.6) kPa. The tissue elasticity figure after treatment was mainly blue with the score of 2.40 ± 0.87, and the Yang's modulus was (29.0 ± 5.9) kPa. Whereas in the control group, the tissue elasticity figure was mainly blue with the score of 1.60 ± 0.72, and the Yang's modulus was (24.0 ± 7.6) kPa. These were statistical differences between the two groups (P = 0.000).

CONCLUSIONSWE can be used as an evaluation method of manipulation treatment for neck-shoulder myofascial pain syndrome, which is an objective and sensitive detection method.

Adult ; Elasticity Imaging Techniques ; methods ; Female ; Humans ; Male ; Middle Aged ; Musculoskeletal Manipulations ; Myofascial Pain Syndromes ; diagnosis ; therapy ; Neck ; Shoulder

BACKGROUND AND OBJECTIVES: Vertigo is an illusion of environmental movement due to various causes, thus it is hard for medical doctors to determine the exact kind of dizziness in the final diagnosis. Recently, cervical vertigo was reported from several vertigo cases. Cervical vertigo is defined as sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine. The aim of our study is to document the clinical features and the treatment outcomes in vertigo patients with myofascial pain syndrome (MPS). SUBJECTS AND METHOD: A total of 488 patients, excluding 18 patients who received other diagnosis, were examined to investigate the reasons for dizziness. We evaluated 34 patients, who were diagnosed with cervical vertigo by questionnaire after MPS treatments. Clinical evaluations for cervical vertigo were performed on all subjects, and vestibular function tests were also performed in patients with vertigo symptoms. All patients received a total of 4 treatments including trigger point injection, physical therapy or medication, and then followed up, respectively. The symptom changes of dizziness, patient satisfaction and cervical pain were checked before and treatment 1, 2, 4 times by Visual Analogue Scale (VAS) score. RESULTS: There were significant improvement in the VAS score of dizziness, patient satisfaction and cervical pain after treatment for MPS. CONCLUSION: Treatment for MPS could improve dizziness in cervical vertigo with MPS patients, but further study is needed to clearly confirm the cervical vertigo with MPS for improving patient's quality of life.
Diagnosis* ; Dizziness ; Facial Neuralgia ; Humans ; Illusions ; Myofascial Pain Syndromes ; Neck ; Neck Pain ; Patient Satisfaction ; Quality of Life ; Surveys and Questionnaires ; Sensation ; Spine ; Trigger Points ; Vertigo* ; Vestibular Function Tests

OBJECTIVES: The objective of this study was to identify the musculoskeletal co-morbidities of neck pain of myofascial origin among IT professionals. METHODS: A retrospective report analysis of 5357 IT professionals from various IT companies in India was conducted. Demographic details, type and intensity of the musculoskeletal problems, employee feedbacks on status of musculoskeletal health and physician's diagnosis were analysed. Descriptive statistics were used to describe the age, gender, body area affected and nature of work. Chi square test was used to find the association between musculoskeletal co-morbidities and myofascial neck pain (MNP). RESULTS: The study participants were predominantly males (71%). 41% of the population used laptops, 35% desktops and 24% both. Neck pain was the commonest reported symptom, followed by low back, shoulder and arm pain respectively. Statistical analysis also revealed that low back pain and shoulder pain, had a significant association with neck pain. Further analysis revealed that there was a significant association between the presence of MNP and thoracic outlet syndrome (p < 0.001) and fibromyalgia syndrome (p < 0.001). Other than the listed co-morbidities, eye strain was also found to be associated with MNP. CONCLUSIONS: Low back pain and shoulder pain was found to be co morbid symptoms noted among IT professionals with MNP. Thoracic outlet syndrome and fibromyalgia were found to be the most commonly associated disorders with MNP among IT professionals.
Arm ; Diagnosis ; Fibromyalgia ; Humans ; India ; Low Back Pain ; Male ; Myofascial Pain Syndromes ; Neck Pain* ; Neck* ; Retrospective Studies ; Shoulder ; Shoulder Pain ; Thoracic Outlet Syndrome

OBJECTIVE: The use of hand held devices (HHD) such as mobile phones, game controls, tablets, portable media players and personal digital assistants have increased dramatically in past decade. While sending a text message or using the controls of the HHD the users need to use their thumb and other palm muscles extensively. The objective of this study was to describe the risk factors and clinical features of the musculoskeletal disorders (MSDs) arising due to usage of hand held devices and to evaluate the effectiveness of a sequenced rehabilitation protocol. METHODS: A retrospective report analysis of 70 subjects, who were diagnosed to have a MSD affecting the upper extremities, was conducted. Medical charts from a tertiary level rehabilitation centre from 2005-2013 were analysed. All the subjects reported pain in their upper extremities following extensive usage of HHD and were examined and diagnosed to have a MSD by an orthopaedic and rehabilitation physician. After the assessment and diagnosis, all the patients underwent rehabilitation using a sequenced protocol. RESULTS: All the subjects reported pain in the thumb and forearm with associated burning, numbness and tingling around the thenar aspect of the hand, and stiffness of wrist and hand. 43 subjects had symptoms on the right side; 9 on left and 18 had bilateral symptoms. Correlation was found between hand dominance and MSD. 33 subjects complained of onset of symptoms following extensive text messaging. All the subjects were diagnosed to have tendinosis of Extensor Pollicis Longus and Myofascial Pain Syndrome affecting the 1st interossei, thenar group of muscles and Extensor Digitorum Communis. 23 of the subjects were senior executives, among these 7 were CEO's of major multinational companies in India. All the subjects recovered completely following the rehabilitation. CONCLUSIONS: The study concluded that mobile phones and gadgets that promoted the predominant usage of thumb or only one finger while texting or using the controls were associated with a higher prevalence of MSDs. Treatment using a sequenced rehabilitation protocol was found to be effective.
Burns ; Cellular Phone ; Diagnosis ; Fingers ; Forearm ; Hand* ; Humans ; Hypesthesia ; India ; Muscles ; Myofascial Pain Syndromes ; Prevalence ; Rehabilitation ; Retrospective Studies ; Risk Factors ; Tablets ; Tendinopathy ; Text Messaging ; Thumb ; Upper Extremity* ; Wrist

OBJECTIVE: To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper arm pain. METHODS: A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS). RESULTS: US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (capital DE, CyrillicVAS=-2.8) was significantly larger than caused by oral NSAID (capital DE, CyrillicVAS=-1.5) (p<0.05). CONCLUSION: In patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of pain is suspected to be originated from the muscle.
Arm* ; Diagnosis ; Humans ; Myofascial Pain Syndromes ; Pilot Projects* ; Prospective Studies ; Rehabilitation ; Rotator Cuff* ; Shoulder Pain ; Trigger Points* ; Ultrasonography ; Visual Analog Scale

To review the literature of acupuncture at trigger point for myofascial pain syndrome from the main selected points (trigger point), the mechanism of Chinese medicine and modern research and its clinical application. The results show that acupuncture at trigger point has significant effect on the myofascial pain syndrome, which could be influenced by the type of needle, manipulation, insertion angle and depth of the needles. However, the involved studies at present are still far from enough and lack of systematic study with multivariate analysis, it is needed to be improved that some problems about the clinical diagnosis and basic research.
Acupuncture Therapy ; Animals ; Humans ; Myofascial Pain Syndromes ; diagnosis ; physiopathology ; therapy ; Trigger Points ; physiopathology

Trigger point injection is a simple procedure that is widely performed for relieving pain. Even though there are several complications of trigger point injection, myositis ossificans has not been documented as one of its complications. We treated a patient who suffered from painful limitation of elbow motion and this was caused by myositis ossificans between the insertions of brachialis and supinator muscles after a trigger point injection containing lidocaine mixed with saline, and we also review the relevant medical literature.
Adult ; Elbow/surgery ; Humans ; Injections, Intralesional/*adverse effects ; Lidocaine/*adverse effects/therapeutic use ; Magnetic Resonance Imaging ; Male ; Myofascial Pain Syndromes/drug therapy ; Myositis Ossificans/diagnosis/*etiology/radiotherapy/surgery ; Range of Motion, Articular

Differential diagnosis of posterior neck and occipital pain is difficult based on symptoms and physical examination only. We report a case of patient who complained of pain in the posterior neck and occiput, with the initial diagnosis of myofascial pain syndrome, but who did not improve with conventional treatments. Magnetic resonance imaging revealed a cervical intraspinal tumor, and the patient developed subsequent motor weakness and sensory changes. Comprehensive diagnostic approaches are strongly recommended when the patient manifests symptoms unresponsive to treatment.
Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Myofascial Pain Syndromes ; Neck ; Neck Pain ; Physical Examination

Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment.
Adult ; Diagnosis, Differential ; Female ; Hemangioma/*diagnosis ; Humans ; Magnetic Resonance Imaging/methods ; Muscle, Skeletal/anatomy & histology/pathology ; Muscular Diseases/*diagnosis ; Myofascial Pain Syndromes/*diagnosis ; Pain ; Radiography/methods ; Time Factors