Scalene Myofascial Pain Syndrome
Myofascial Pain Syndrome (MPS) is a chronic regional pain syndrome that can present with excessively irritable spots known as trigger points. These trigger points arise from taut bands in the skeletal muscles, which can then cause abnormal referred pain patterns that is specific to the muscle involved. The muscles can become weak and stiff with decreased range of motion. Scalene Myofascial Pain Syndrome is a regional pain syndrome in which pain originates over the neck area and radiates down the arm. It can occur as primary (chronic muscle overuse, poor posture, and repetitive microtruama) or secondary (osteoarthritis, trauma, complex regional pain syndrome, and systemic illnesses) to underlying cervical pathology. It is often misdiagnosed as cervical radiculopathy or associated diagnosis such as cervical disc herniation/prolapse, cervical stenosis, and thoracic outlet syndrome.
MPS of pectoralis minor, scalene and serratus anterior can resemble cervical radiculopathy. Each muscle needs to be ruled out when assessing patient’s with neck pain and radicular symptoms.
Signs & Symptoms
Referred pain can be in the radial distribution of the arm/hand, which stimulates C6 radicular pain. This referred pain can also be due to brachial plexus irritation due to direct compression between the two scalene muscles, which could cause thoracic outlet syndrome.
Management of Scalene MPS includes: eliminating the trigger points by stretching, massage, deep heat therapy, medications, and trigger point injections
MPS of pectoralis minor, scalene and serratus anterior can resemble cervical radiculopathy. Each muscle needs to be ruled out when assessing patient’s with neck pain and radicular symptoms.
- Pectoralis Minor can yield neck and shoulder pain, which can radiate along the arm. This stimulates C7/C8 radiculopathy.
- Serratus anterior can cause pain in the chest under the axilla, which can radiate down the ulnar part of the arm. This also stimulates C7/C8 radiculopathy.
Signs & Symptoms
- Pain in cervical region radiating to occiput, nuchal muscles, shoulders and upper extremities
- Stiffness
- Tenderness to the trapezius, levator scapulae, rhomboids, supraspinatus, and infraspinatus.
- Unilateral neck/shoulder pain
Referred pain can be in the radial distribution of the arm/hand, which stimulates C6 radicular pain. This referred pain can also be due to brachial plexus irritation due to direct compression between the two scalene muscles, which could cause thoracic outlet syndrome.
Management of Scalene MPS includes: eliminating the trigger points by stretching, massage, deep heat therapy, medications, and trigger point injections
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