Myofascial syndrome and pain: A neurophysiological approach

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Myofascial syndrome and pain: A neurophysiological approach Juhani V. Partanen, Tuula A. Ojala, Jari P.A. Arokoski Pathophysiology Volume 17, Issue 1, Pages 19-28 (February 2010) DOI: 10.1016/j.pathophys.2009.05.001 Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 1 Typical end plate spikes (EPSs) as seen in needle electromyography in an active spot of a relaxed gastrocnemius muscle. Note the occurrence of EPSs with a negative onset (upwards) and others with a positive onset (downwards) as well (arrows, inset). There is end plate noise (MEPPs) in the background. Pathophysiology 2010 17, 19-28DOI: (10.1016/j.pathophys.2009.05.001) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 2 A schema illustrating the sensory innervation of the muscle spindle. In addition to the Ia and II afferents the presence of III- and IV-afferents with free nerve endings was observed. Pathophysiology 2010 17, 19-28DOI: (10.1016/j.pathophys.2009.05.001) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 3 A complex repetitive discharge (40Hz) recorded from a painful trigger point in the levator scapulae muscle of a patient with myofascial syndrome. There were no signs of peripheral neuropathy in this patient. Pathophysiology 2010 17, 19-28DOI: (10.1016/j.pathophys.2009.05.001) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions

Fig. 4 A schema illustrating the taut band. Striped muscle fibres are extrafusal beta muscle fibres in silent contracture. The inflamed muscle spindles are red. The divergent beta innervation (illustrated from the right side of the figure) to several muscle spindles as well as to extrafusal beta fibres forms the pathway for concomitant III- and IV-afferent reflex drive (positive feedback loop) to both of them. Light grey muscle fibres are innervated by alpha motor neurons at the end plate zone (not illustrated) and they are capable to produce the local twitch response of the taut band when Ia afferents are stimulated. Pathophysiology 2010 17, 19-28DOI: (10.1016/j.pathophys.2009.05.001) Copyright © 2009 Elsevier Ireland Ltd Terms and Conditions