Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2013

Open Access 01-12-2013 | Research article

Myofascial trigger points and innervation zone locations in upper trapezius muscles

Published in: BMC Musculoskeletal Disorders | Issue 1/2013

Login to get access

Abstract

Background

Myofascial trigger points (MTrPs) are hyperirritable spots located in taut bands of muscle fibres. Electrophysiological studies indicate that abnormal electrical activity is detectable near MTrPs. This phenomenon has been described as endplate noise and it has been purported to be associated MTrP pathophysiology. Thus, it is suggested that MTrPs will be overlap the innervation zone (IZ). The purpose of this work was to describe the location of MTrPs and the IZ in the right upper trapezius.

Methods

We screened 71 individuals and eventually enrolled 24 subjects with neck pain and active MTrPs and 24 neck pain-free subjects with latent MTrPs. Surface electromyography (sEMG) signals were detected using an electrode matrix during isometric contraction of the upper trapezius. A physiotherapist subsequently examined the subject’s trapezius to confirm the presence of MTrPs and establish their location. IZ locations were identified by visual analysis of sEMG signals. IZ and MTrPs locations were described using an anatomical coordinate system (ACS), with the skin area covered by the matrix divided into four quadrants.

Results

No significant difference was observed between active and latent MTrPs locations (P = 0.6). Forty-five MTrPs were in the third quadrant of the ACS, and 3 were included in second quadrant. IZs were located approximately midway between the seventh cervical vertebrae and the acromial angle in a limited area in the second and third quadrants. The mean distance between MTrP and IZ was 10.4 ± 5.8 mm.

Conclusions

According to the acquired results, we conclude that IZ and MTrPs are located in well-defined areas in upper trapezius muscle. Moreover, MTrPs in upper trapezius are proximally located to the IZ but not overlapped.
Appendix
Available only for authorised users
Literature
1.
Abasolo L, Blanco M, Bachiller J, Candelas G, Collado P, Lajas C, Revenga M, Ricci P, Lazaro P, Aguilar MD: A health system program to reduce work disability related to musculoskeletal disorders. Ann Intern Med. 2005, 143 (6): 404-414. 10.7326/0003-4819-143-6-200509200-00005.CrossRefPubMed
2.
Mense S, Simons DG, Russell IJ: Muscle pain : understanding its nature, diagnosis, and treatment. 2000, Baltimore, Md: Lippincott Williams & Wilkins
3.
Han SC, Harrison P: Myofascial pain syndrome and trigger-point management. Reg Anesth. 1997, 22 (1): 89-101. 10.1016/S1098-7339(06)80062-3.CrossRefPubMed
4.
Travell JG, Simons DG: Myofascial pain and dysfunction: the trigger point manual. 1983, Baltimore; London: Williams & Wilkins
5.
Simons D: Clinical and etiological update of myofascial pain from trigger points. J Musculoskeletal Pain. 1996, 4: 97-125. 10.1300/J094v04n03_10.CrossRef
6.
Hong CZ, Simons DG: Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil. 1998, 79 (7): 863-872. 10.1016/S0003-9993(98)90371-9.CrossRefPubMed
7.
Kuan TS: Current studies on myofascial pain syndrome. Curr Pain Headache Rep. 2009, 13 (5): 365-369. 10.1007/s11916-009-0059-0.CrossRefPubMed
8.
Simons DG: Do endplate noise and spikes arise from normal motor endplates?. Am J Phys Med Rehabil. 2001, 80 (2): 134-140. 10.1097/00002060-200102000-00012.CrossRefPubMed
9.
Simons DG: New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil. 2008, 89 (1): 157-159. 10.1016/j.apmr.2007.11.016.CrossRefPubMed
10.
Simons DG, Hong CZ, Simons LS: Endplate potentials are common to midfiber myofacial trigger points. Am J Phys Med Rehabil. 2002, 81 (3): 212-222. 10.1097/00002060-200203000-00010.CrossRefPubMed
11.
Coërs C, Woolf AL: The innervation of muscle. 1959, Oxford: Blackwell Scientific Publications, Inc
12.
Kim MW, Kim JH, Yang YJ, Ko YJ: Anatomic localization of motor points in gastrocnemius and soleus muscles. Am J Phys Med Rehabil. 2005, 84 (9): 680-683. 10.1097/01.phm.0000176341.85398.a9.CrossRefPubMed
13.
Parratte B, Tatu L, Vuillier F, Diop M, Monnier G: Intramuscular distribution of nerves in the human triceps surae muscle: anatomical bases for treatment of spastic drop foot with botulinum toxin. Surg Radiol Anat. 2002, 24 (2): 91-96. 10.1007/s00276-002-0022-9.CrossRefPubMed
14.
Prodanov D, Thil MA, Marani E, Delbeke J, Holsheimer J: Three-dimensional topography of the motor endplates of the rat gastrocnemius muscle. Muscle Nerve. 2005, 32 (3): 292-302. 10.1002/mus.20378.CrossRefPubMed
15.
Hubbard DR, Berkoff GM: Myofascial trigger points show spontaneous needle EMG activity. Spine (Phila Pa 1976). 1993, 18 (13): 1803-1807. 10.1097/00007632-199310000-00015.CrossRef
16.
Kuan TS, Hong CZ, Chen JT, Chen SM, Chien CH: The spinal cord connections of the myofascial trigger spots. Eur J Pain. 2007, 11 (6): 624-634. 10.1016/j.ejpain.2006.10.001.CrossRefPubMed
17.
18.
Kuan TS, Chen JT, Chen SM, Chien CH, Hong CZ: Effect of botulinum toxin on endplate noise in myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil. 2002, 81 (7): 512-520. 10.1097/00002060-200207000-00008. quiz 521–513CrossRefPubMed
19.
Mense S, Simons DG, Hoheisel U, Quenzer B: Lesions of rat skeletal muscle after local block of acetylcholinesterase and neuromuscular stimulation. J Appl Physiol. 2003, 94 (6): 2494-2501.CrossRefPubMed
20.
Simons DG, Stolov WC: Microscopic features and transient contraction of palpable bands in canine muscle. Am J Phys Med. 1976, 55 (2): 65-88.PubMed
21.
Shah JP, Gilliams EA: Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. 2008, 12 (4): 371-384. 10.1016/j.jbmt.2008.06.006.CrossRefPubMed
22.
Shah JP, Phillips TM, Danoff JV, Gerber LH: An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005, 99 (5): 1977-1984. 10.1152/japplphysiol.00419.2005.CrossRefPubMed
23.
Simons DG: Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004, 14 (1): 95-107. 10.1016/j.jelekin.2003.09.018.CrossRefPubMed
24.
Soares A, Andriolo RB, Atallah AN, da Silva EM: Botulinum toxin for myofascial pain syndromes in adults. Cochrane Database Syst Rev. 2012, 4: CD007533-PubMed
25.
Delnooz CC, van de Warrenburg BP: Current and future medical treatment in primary dystonia. Ther Adv Neurol Disord. 2012, 5 (4): 221-240. 10.1177/1756285612447261.CrossRefPubMedPubMedCentral
26.
Barbero M, Gatti R, Lo Conte L, Macmillan F, Coutts F, Merletti R: Reliability of surface EMG matrix in locating the innervation zone of upper trapezius muscle. J Electromyogr Kinesiol. 2011, 21 (5): 827-833. 10.1016/j.jelekin.2011.05.013.CrossRefPubMed
27.
Masuda T, Miyano H, Sadoyama T: The distribution of myoneural junctions in the biceps brachii investigated by surface electromyography. Electroencephalogr Clin Neurophysiol. 1983, 56 (6): 597-603. 10.1016/0013-4694(83)90027-5.CrossRefPubMed
28.
Merletti R, Farina D, Gazzoni M: The linear electrode array: a useful tool with many applications. J Electromyogr Kinesiol. 2003, 13 (1): 37-47. 10.1016/S1050-6411(02)00082-2.CrossRefPubMed
29.
Saitou K, Masuda T, Michikami D, Kojima R, Okada M: Innervation zones of the upper and lower limb muscles estimated by using multichannel surface EMG. J Hum Ergol (Tokyo). 2000, 29 (1–2): 35-52.
30.
Bogduk N, McGuirk B: Medical management of acute and chronic neck pain: an evidence-based approach. 2006, Edinburgh: Elsevier
31.
Myburgh C, Larsen AH, Hartvigsen J: A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil. 2008, 89 (6): 1169-1176. 10.1016/j.apmr.2007.12.033.CrossRefPubMed
32.
Merletti R, Farina D, Granata A: Non-invasive assessment of motor unit properties with linear electrode arrays. Electroencephalogr Clin Neurophysiol Suppl. 1999, 50: 293-300.PubMed
33.
Johnson G, Bogduk N, Nowitzke A, Huose D: Anatomy and actions of the trapezius. Clin Biomech. 1994, 9: 44-50. 10.1016/0268-0033(94)90057-4.CrossRef
34.
Kuan TS, Hsieh YL, Chen SM, Chen JT, Yen WC, Hong CZ: The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise. Am J Phys Med Rehabil. 2007, 86 (3): 183-189. 10.1097/PHM.0b013e3180320ea7.CrossRefPubMed
35.
Fischer AA: Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain. 1987, 28 (3): 411-414. 10.1016/0304-3959(87)90074-1.CrossRefPubMed
36.
Sciotti VM, Mittak VL, DiMarco L, Ford LM, Plezbert J, Santipadri E, Wigglesworth J, Ball K: Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 2001, 93 (3): 259-266. 10.1016/S0304-3959(01)00325-6.CrossRefPubMed
37.
Fernandez-de-las-Penas C, Alonso-Blanco C, Miangolarra JC: Myofascial trigger points in subjects presenting with mechanical neck pain: a blinded, controlled study. Man Ther. 2007, 12 (1): 29-33. 10.1016/j.math.2006.02.002.CrossRefPubMed
38.
Barbero M, Bertoli P, Cescon C, Macmillan F, Coutts F, Gatti R: Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle. J Man Manipulative Ther. 2012, 20 (4): 171-177. 10.1179/2042618612Y.0000000010.CrossRef
39.
Njoo KH, Van der Does E: The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice. Pain. 1994, 58 (3): 317-323. 10.1016/0304-3959(94)90125-2.CrossRefPubMed
40.
Wolfe F, Simons DG, Fricton J, Bennett RM, Goldenberg DL, Gerwin R, Hathaway D, McCain GA, Russell IJ, Sanders HO: The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. J Rheumatol. 1992, 19 (6): 944-951.PubMed
41.
Alonso-Blanco C, de-la-Llave-Rincon AI, Fernandez-de-las-Penas C: Muscle trigger point therapy in tension-type headache. Expert Rev Neurother. 2012, 12 (3): 315-322. 10.1586/ern.11.138.CrossRefPubMed
42.
Bron C, Dommerholt J, Stegenga B, Wensing M, Oostendorp RA: High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain. BMC Musculoskelet Disord. 2011, 12: 139-10.1186/1471-2474-12-139.CrossRefPubMedPubMedCentral
43.
Itza F, Zarza D, Serra L, Gomez-Sancha F, Salinas J, Allona-Almagro A: [Myofascial pain syndrome in the pelvic floor: a common urological condition]. Actas Urol Esp. 2010, 34 (4): 318-326. 10.1016/S2173-5786(10)70077-9.CrossRefPubMed
44.
Skootsky SA, Jaeger B, Oye RK: Prevalence of myofascial pain in general internal medicine practice. West J Med. 1989, 151 (2): 157-160.PubMedPubMedCentral
45.
Ramachandran M, Eastwood DM: Botulinum toxin and its orthopaedic applications. J Bone Joint Surg Br. 2006, 88 (8): 981-987.CrossRefPubMed
Metadata
Title
Myofascial trigger points and innervation zone locations in upper trapezius muscles
Publication date
01-12-2013
Published in
BMC Musculoskeletal Disorders / Issue 1/2013
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-14-179

Other articles of this Issue 1/2013

BMC Musculoskeletal Disorders 1/2013 Go to the issue

Research article

Muscle activity and head kinematics in unconstrained movements in subjects with chronic neck pain; cervical motor dysfunction or low exertion motor output?

Research article

An ultrasound study of altered hydration behaviour of proteoglycan-degraded articular cartilage

Research article

Association of back pain with hypovitaminosis D in postmenopausal women with low bone mass

Research article

Substitutes of structural and non-structural autologous bone grafts in hindfoot arthrodeses and osteotomies: a systematic review

Research article

A 5 item version of the Compliance Questionnaire for Rheumatology (CQR5) successfully identifies low adherence to DMARDs

Research article

Aging is associated with increased activities of matrix metalloproteinase-2 and -9 in tenocytes