Background: Myofascial trigger points (MTrPs) are commonly observed in the neck, parascapular region, and upper back muscles of patients with cervical pathology.
Aim: To assess the frequency of latent and active myofascial trigger point (aMTrP) in the neck and upper back muscles in patients with cervical radiculopathy and healthy subjects.
Design: Controlled clinical trials.
Setting: Outpatients and controls.
Population: Two hundred and forty four patients and 122 controls
Methods: The patients clinically diagnosed as cervical radiculopathy with positive Spurling's test and confirmed by MRI, were enrolled in this study. All subjects were examined for active and latent MTrP. In patients with cervical radiculopathy, an aMTrP was distinguished from a latent one when the referred pain elicited by exploration of the MTrP is recognized as familiar.
Results: The patients comprised of 128 female (52.5%) and 116 male (47.5%) patients. Mean age was 44.58(20-65 years). In 125 (51.2%) of patients with cervical radiculopathy were found an aMTrP at least one muscle from upper trapezius, multifidus, splenius capitis, levator scapulae, rhomboid major, minor and deep paraspinal muscles. Number and distribution of MTrPs in patients with 244 cervical radiculopathy and in healthy controls. aMTrPs were detected most common in levator scapula (16.3%), splenius capitis (14.7%), rhomboid minor (14.3%), upper part of trapezius (13.5%), rhomboid major (10.2%) and multifidus (8.6%) muscles. Patients with cervical radiculopathy showed latent MTrP in levator scapula (27%), splenius capitis (16.8%), rhomboid minor (24.6%), upper part of trapezius (33.2%), rhomboid major (9%) and multifidus (8.2%) muscles. There was significant difference in terms of distribution of active and latent MTrPs in patients with cervical radiculopathy (P=0.019). Number of latent MTrPs in upper trapezius muscles in patients with cervical radiculopathy was more than the expected distribution. None of the subjects of control group had aMTrP. However, healthy controls showed latent MTrP in levator scapula (33.6%), splenius capitis (16.4%), rhomboid minor (21.3%), upper part of trapezius (40.2%), rhomboid major (6.5%) and multifidus (17.2%) muscles. There was no significant difference in terms of distribution of latent MTrPs between cervical radiculopathy and control groups (P=0.249). The frequency of aMTrP was found to be significantly higher in CDH with median localization as compared to posterolateral herniations (P=0.041). After conservative treatment for two weeks, number of patients with active MTrP in cervical radiculopathy were decreased about 50%.
Conclusion: Cervical root compression would be considered as the starting or maintaining factor of aMTrP.
Clinical rehabilitation impact: The treatment of cervical radiculopathy might be facilitated the improving in aMTrPs located in aforementioned muscles.