Symptomatology and clinical pathophysiology of myofascial pain.

Myofascial pain syndromes, fibromyalgia, and articular dysfunctions may all be contributing to our patients' ubiquitous musculoskeletal pain problems that generally are poorly understood and poorly managed. Thepectoralis minor myofascial pain syndrome, for example, results from trigger points (TrPs) activated by stress overload of the muscle. Symptoms of pain referred to the shoulder and ulnar aspect of the arm and forearm, and of pain on reaching around and behind the body, are characteristic. Findings include restricted stretch range of motion and some weakness of the muscle, taut bands of muscle fibers, and focal trigger point tenderness of each taut band on palpation. Snapping palpation at the TrP elicits a local twitch response (LTR). The increased muscle tension of a pectoralis minor syndrome commonly entraps the lower trunk of the brachial plexus, producing symptoms of a cervical radiculopathy.