1. RESULTS : Table 1: Demographics
Factors associated with presence of tender trigger points on shoulder girdle muscles in Occipital neuralgia Soma Sahai-Srivastava, M.D. , Dawood Subhani, MBBS University of Southern California, Los Angeles, California
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Background & Methods
Results
The I.H.S. criteria for Occipital neuralgia (ON) include 1. Unilateral headache, continuous or paroxysmal 2. diminished sensation or dysaesthesia in the affected area. 3. Circumscribed tenderness over the GON as it crosses the superior Nuchal line 4. Relief of acute attack by local anesthetic block
Diagnostic criteria for Fibromyalgia comprise presence of 18 symmetric tender trigger points including those on the Trapezius, rhomboid and suboccipital notch.
Retrospective chart review of 94 consecutive patients presenting ( Jan 2011) with ON.
Ours is the first large case series study reporting the presence of tender trigger points on shoulder girdle muscles in ON in the absence of Fibromyalgia.
44 ON (47%) patients had at least 1 Trigger point (TP) of which 31 received Trigger point injection (TPI). 18 patients had TPI on Trapezius and 26 on the Rhomboids.
Of the 61 patients who received bilateral ONB, 13 (21%) had bilateral Trapezius TPI ( p=0.06) and 11 had bilateral Rhomboids TPI (18%).
The correlation of laterality of ON block (ONB) with TPI showed a non significant trend towards bilateral Trapezius TP in bilateral ONB patients.
RESULTS : Table 1: Demographics
ON Block
Trigger Points
No of subjects 94
44 ( 47%)
Age (years), mean
54.3 53
Female, no. (%)
54 (57)
31 (71)
Race, no. (%)
White
55 (58 )
27 (61)
Hispanic
29 (31)
1 4(32)
African American
2 (2)
1 (2)
Asian
8 (8)
2 (5)
Migraineurs
44 (47)
20 (48)
Bilateral
61 (64)
24 (21)
Methods
Conclusion
ON patients should be screened for tender trigger points on Trapezius and Rhomboid muscles even in the absence of Fibromyalgia.
Bilateral ON may have a higher frequency of bilateral trigger points.
References
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Abeles M,Campbell SM,Clark P et al. The American College of Rheumatology 1990 Criteria for
The Classification of Fibromyalgia: Report of Multicenter Criteria Committee Arthritis
Rheumatism 1990; 33:
None of the patients had a history of Fibromyalgia
All patients reported pain relief with injections.
There was no correlation between age, gender, race, history of migraine headache and presence of TP