title: High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain.
abstract: BACKGROUND
  Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain.
  
  
  METHODS
  An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72) for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ) was used to test for association between variables.
  
  
  RESULTS
  MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active MTrPs) and 4 (latent MTrPs). Active MTrPs were most prevalent in the infraspinatus (77%) and the upper trapezius muscles (58%), whereas latent MTrPs were most prevalent in the teres major (49%) and anterior deltoid muscles (38%). The number of muscles with active MTrPs was only moderately correlated with the DASH score.
  
  
  CONCLUSIONS
  The prevalence of muscles containing active and latent MTrPs in a sample of patients with chronic non-traumatic shoulder pain was high.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands. carelbron@mac.com
authors.forename: Carel
authors.initials: C
authors.lastname: Bron
authors.forename: Jan
authors.initials: J
authors.lastname: Dommerholt
authors.forename: Boudewijn
authors.initials: B
authors.lastname: Stegenga
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Rob A B
authors.initials: RA
authors.lastname: Oostendorp
mesh_terms: D000328:Adult; D015897:Comorbidity / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000503:physiopathology*; D009209:Myofascial Pain Syndromes / Q000453:epidemiology* / Q000503:physiopathology* / Q000534:rehabilitation; D010147:Pain Measurement / Q000379:methods; D053591:Referred Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D026741:Physical Therapy Modalities / Q000592:standards; D011237:Predictive Value of Tests; D015995:Prevalence; D012720:Severity of Illness Index; D020069:Shoulder Pain / Q000453:epidemiology* / Q000503:physiopathology* / Q000534:rehabilitation