title: Pathological mechanisms implicated in localized female trapezius myalgia.
abstract: Myalgia localized to the neck and shoulder in women is a growing problem both in the general population and in the industrial world. The aim of this study was to investigate the mechanisms involved in work-related myalgia. In 21 women (age, 38.7+/-5.5 years), muscle biopsies were obtained from the upper part of the trapezius and the morphologic and metabolic characteristics of muscle fibres were analyzed. The patients indicated the number of painful areas on a pain drawing and the intensity of pain was assessed using a visual analogue scale (VAS). Two groups were formed on the basis of the median values: lower pain level and higher pain level. Trapezius muscles were characterized by the large size of type I fibres and the low capillary to fibre area ratio for both type I and type IIA fibres. Patients with the highest pain scores had the lowest capillary to fibre area ratio for type I fibres (coefficient correlation r = -0.45 and P < 0.05). Moreover, the proportion of cytochrome c oxidase (COX)-negative fibres seen in the cross-sections was significantly higher in the group of patients which had the higher pain and more painful areas than in the group of patients with lower pain level and painful areas (P < 0.05). The significant increase (P < 0.05) of the size of the type I fibres in trapezius myalgia point to the special strain imposed upon type I muscle fibres during work tasks. Cytochrome oxidase c deficiency which is indicative of an energy crisis within muscle cells and the low capillary to fibre area ratio which might impair oxygen delivery and removal of metabolites in the working muscles are both associated with pain in the trapezius muscle.
authors.affiliation: Department of Anatomy, Umeå University, S-901 87, Umeå, Sweden Laboratoire de Physiologie et Biologie de la Motricité. URA CNRS 1448, UFR Biomédicale des St Pères, 75005, Paris, France Department of Musculoskeletal Research, National Institute for Working Life, Umeå University, S-901 87, Umeå, Sweden Department of Occupational and Environmental Medicine, Umeå University, S-901 87, Umeå, Sweden Department of Plastic Surgery, Norrland University Hospital, 901 87 Umeå, Sweden.
authors.forename: Fawzi
authors.initials: F
authors.lastname: Kadi
authors.forename: Kerstin
authors.initials: K
authors.lastname: Waling
authors.forename: Christina
authors.initials: C
authors.lastname: Ahlgren
authors.forename: Gunnevi
authors.initials: G
authors.lastname: Sundelin
authors.forename: Staffan
authors.initials: S
authors.lastname: Holmner
authors.forename: Gillian S
authors.initials: GS
authors.lastname: Butler-Browne
authors.forename: Lars-Eric
authors.initials: LE
authors.lastname: Thornell
mesh_terms: D000328:Adult; D002196:Capillaries / Q000473:pathology; D003576:Electron Transport Complex IV / Q000378:metabolism; D005260:Female; D006801:Humans; D008931:Mitochondria, Muscle / Q000201:enzymology / Q000473:pathology; D018485:Muscle Fibers, Skeletal / Q000201:enzymology / Q000473:pathology; D018482:Muscle, Skeletal / Q000098:blood supply / Q000201:enzymology / Q000473:pathology / Q000503:physiopathology*; D009135:Muscular Diseases / Q000201:enzymology / Q000473:pathology / Q000503:physiopathology*; D009243:NAD / Q000378:metabolism; D012782:Shoulder / Q000473:pathology / Q000503:physiopathology*; D020069:Shoulder Pain / Q000503:physiopathology*
chemical_list: D009243:NAD; D003576:Electron Transport Complex IV