Myofascial Trigger Point
The term for a painful knot along the scapula is a "myofascial trigger point." 1, 2
Definition and Characteristics
A myofascial trigger point is a hyperirritable spot within a taut band of skeletal muscle that is painful on compression and can produce characteristic referred pain, motor dysfunction, and autonomic phenomena. 1 These are palpable as discrete, hard nodules or cord-like bands within a sharply circumscribed area of extreme tenderness in the muscle and/or fascia. 2, 3
Trigger points are most commonly found in muscles involved in postural support, including the neck, shoulders, and scapular region—precisely where you're describing the painful knot. 2, 4
Clinical Presentation
- Active trigger points are spontaneously painful without compression 3
- Latent trigger points are painful only when compressed 3
- Palpation typically elicits pain directly over the affected area and/or causes radiation of pain toward a zone of reference, often accompanied by a local twitch response 4
- Patients experience regional, persistent pain with decreased range of motion in the affected muscles 4
Pathophysiology
The development of trigger points results from acute trauma or repetitive microtrauma that creates stress on muscle fibers. 4 Recent scientific evidence suggests that the soft tissue milieu around the trigger point, neurogenic inflammation, sensitization, and limbic system dysfunction may all contribute to the initiation, amplification, and perpetuation of myofascial pain syndrome. 3
Treatment Approaches
Trigger point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms. 4 Other effective treatments include:
- Spray and stretch technique 1, 4
- Transcutaneous electrical stimulation 1
- Physical therapy and massage 1
- Dry needling 1
- Injections with local anesthetics, corticosteroids, or botulinum toxin 1
In appropriately selected patients, myofascial trigger point injections can be helpful in decreasing pain and improving range of motion when used in conjunction with a comprehensive exercise and rehabilitation program. 5