Myofascial Pain Syndrome
The diagnosis is myofascial pain syndrome (MPS), characterized by the presence of myofascial trigger points within taut bands of the paracervical and trapezius muscles. 1, 2
Diagnostic Criteria
The diagnosis of MPS is established through muscle palpation revealing specific physical findings: 3
- Hyperirritable spots within taut bands of skeletal muscle that are painful on compression 1
- Tender points localized to the bilateral paracervical muscles and trapezius as described in this patient 2
- Restricted range of motion of the affected muscle groups 2
- Referred pain patterns that follow characteristic myotomal distributions when trigger points are stimulated 2
Key Clinical Features
MPS presents as a chronic regional pain condition with distinctive characteristics: 4
- Taut bands of muscle fibers are palpable on examination, representing contracted muscle segments 3
- Localized tenderness at trigger point sites with potential radiation to distant areas 1
- Bilateral involvement of paracervical and trapezius muscles is common in patients with postural strain or repetitive muscle overuse 4
- Associated muscle dysfunction including weakness and restricted movement 1
Pathophysiology
The trigger points in MPS have well-described electrophysiologic properties and biochemical derangements: 3
- Localized muscle contracture creates the palpable taut band 2
- Biochemical milieu alterations at the trigger point site contribute to pain perpetuation 3
- Contributing factors include muscle overuse, postural imbalance, systemic conditions, and psychological influences 4
Differential Diagnosis Considerations
While the clinical presentation strongly suggests MPS, several conditions must be excluded: 2
- Fibromyalgia presents with widespread pain rather than regional muscle-specific tenderness 2
- Bursitis and tendonitis cause pain at joint structures rather than within muscle bellies 2
- Cervical radiculopathy would present with dermatomal sensory changes and radicular pain patterns 5
- Cervical strain following trauma may coexist but typically includes neck stiffness and occipital headache 5
Important Clinical Pitfall
MPS often coexists with other soft-tissue conditions and is not a diagnosis of exclusion. 2 The presence of trigger points does not rule out concurrent bursitis, tendonitis, or other musculoskeletal pathology. A comprehensive evaluation should assess for these overlapping conditions rather than assuming a single diagnosis explains all symptoms. 2
Confirmation of Diagnosis
No imaging or laboratory studies are required for diagnosis—MPS is a clinical diagnosis made by physical examination alone. 3 The identification of tender trigger points within taut bands of the paracervical and trapezius muscles in this patient confirms the diagnosis without need for additional testing. 1, 3