From the Guidelines
Myofascial pain syndrome (MPS) mimics rotator cuff dysfunction because both conditions affect the same shoulder region and present with similar symptoms, particularly pain and restricted range of motion. In myofascial pain syndrome, trigger points develop in the muscles surrounding the shoulder joint, including the trapezius, levator scapulae, and rotator cuff muscles themselves. These trigger points refer pain to areas typically affected in rotator cuff injuries, creating confusion in diagnosis. The key difference is that myofascial pain stems from muscle tightness and trigger points rather than structural damage to the rotator cuff tendons.
Key Differences and Similarities
- Both conditions present with pain and restricted range of motion in the shoulder region
- Myofascial pain syndrome is characterized by trigger points in the muscles surrounding the shoulder joint
- Rotator cuff dysfunction is often associated with structural damage to the rotator cuff tendons
Treatment Options
Treatment for myofascial pain typically includes:
- Trigger point injections with lidocaine (1-2 mL per trigger point)
- Dry needling
- Manual pressure release techniques
- Physical therapy focusing on gentle stretching and strengthening exercises, performed 2-3 times weekly for 4-6 weeks
- Heat application for 15-20 minutes several times daily to relax tight muscles
- Medications like cyclobenzaprine 5-10mg at bedtime or NSAIDs such as ibuprofen 400-600mg three times daily to provide relief, as suggested by 1 and 1. The underlying physiology involves sustained muscle contraction creating localized ischemia and sensitization of nerve endings, perpetuating a pain cycle that mimics the mechanical pain of actual rotator cuff tears or impingement. According to the most recent study 1, high-quality studies comparing the outcomes of surgical and nonsurgical management of rotator cuff pathology of all types remain a major gap in knowledge, highlighting the need for further research in this area. However, based on the available evidence, a comprehensive treatment approach addressing both the trigger points and the underlying muscle tightness is essential for effective management of myofascial pain syndrome.
From the Research
Myofascial Pain Syndrome and Rotator Cuff Dysfunction
- Myofascial pain syndrome (MPS) can mimic rotator cuff dysfunction due to the presence of myofascial trigger points (MTrPs) in the shoulder muscles, which can cause pain, functional limitation, and alterations in quality of movement 2.
- MTrPs can coexist with degenerative subacromial conditions, such as rotator cuff tendinopathy, and can perpetuate and aggravate the problem if not taken into consideration 2.
- The symptoms of MPS can be similar to those of rotator cuff dysfunction, including pain and limited range of motion, making diagnosis and treatment challenging 3.
Clinical Presentation and Diagnosis
- MPS can present with a complex of symptoms, including referred pain, limited range of motion, and muscle imbalance, which can be similar to those of rotator cuff dysfunction 4.
- The diagnosis of MPS is based on the presence of MTrPs, which can be identified through physical examination and palpation 5.
- Imaging studies, such as ultrasonography and magnetic resonance imaging, may not be able to detect MTrPs, making clinical diagnosis essential 2.
Treatment and Management
- Treatment of MPS typically involves a multimodal approach, including injection therapy, physical therapy, postural or ergonomic correction, and treatment of underlying musculoskeletal pain generators 6.
- Dry needling and other physical therapy modalities can be effective in inactivating MTrPs and reducing symptoms of MPS 3.
- Early treatment of MPS can prevent chronification and improve outcomes, highlighting the importance of prompt diagnosis and intervention 4.