COLLEGE OF PHYSICAL AND RESPIRATORY THERAPY

S.Y. 2016-2017

SEMINAR 1

MEDICAL BACKGROUND ON

MYOFASCIAL PAIN SYNDROME

SUBMITTED TO:

Bernardo Tayaban Jr., PTRP

Maverick Kaypee Colet, PTRP

SUBMITTED BY:

Andrada, Dune Abraham A.

Agra, Crissa Julienne E.
Anin, Jerna C.
Campos, Bianca Joyce U.
Casil, Gabrielle Pauline C.
Gurtiza, Joanna Eden A.
Ormita, Ricah Mae
I. Introduction

II. Definition of Terms

III. Epidemiology

 Sex
- Commonly seen in women
 Age
- 20-50 y/o
 Work
- Sedentary jobs and lifestyle than in those who engage in regular physical
activity.
 Race
- No racial differences in the incidence of myofascial pain.
 Personality
- Typical is that of a worrier who has many real or perceived responsibilies and
who
-

IV. Anatomy, Physiology, Kinesiology

Classification of Joints

Joints are classified by structure and by function.

 Structural classification focuses on the material binding the bones together and
whether or not a joint cavity is present.
o Fibrous: immovable
o Cartilaginous: both rigid and slightly movable
o synovial joints: freely movable
 Functional classification is based on the amount of movement allowed at the joint.
o synarthroses: which are immovable joints;
o amphiarthroses: slightly movable joints;
o diarthroses: freely movable joints.

Fibrous Joints
 The bones are joined by fibrous tissue, namely dense fibrous connective tissue, and no
joint cavity is present.
 The amount of movement allowed depends on the length of the connective tissue fibers
uniting the bones.
 Most fibrous joints are immovable, although a few are slightly movable.
 The three types of fibrous joints are :
o Sutures: “seams,” occur only between bones of the skull
 o Syndesmoses: the bones are connected exclusively by ligaments, cords or
bands of fibrous tissue.
o Gomphoses: is a peg-in-socket fibrous joint

Cartilaginous Joints
 the articulating bones are united by cartilage.
 they lack a joint cavity and are not highly movable.
 The two types of cartilaginous joints are:
o synchondroses : bar or plate of hyaline cartilage unites the bones
o symphyses: A joint where fibrocartilage unites the bone

Synovial Joints
 are those in which the articulating bones are separated by a fluid-
containing joint cavity.
.
 General Structure
Synovial joints have six distinguishing features

1. Articular cartilage:
 Glassy-smooth hyaline cartilage
covers the opposing bone surfaces
as articular cartilage.
 These thin (1 mm or less) but
spongy cushions absorb
compression placed on the joint and
 thereby keep the bone ends from being crushed.
2. Joint (articular) cavity.
 A feature unique to synovial joints, the joint cavity is really just a potential
space that contains a small amount of synovial fluid.
3. Articular capsule.
 The joint cavity is enclosed by a two-layered articular capsule, or joint
capsule.
 The tough external fibrous layer:
 is composed of dense irregular connective tissue that is continuous
with the periostea of the articulating bones.
 It strengthens the joint so that the bones are not pulled apart.
 The inner layer of the joint capsule is a synovial membrane
 composed of loose connective tissue.
 it covers all internal joint surfaces that are not hyaline cartilage.
 The synovial membrane’s function is to make synovial fluid.
4. Synovial fluid.
 A small amount of slippery synovial fluid occupies all free spaces within
the joint capsule.
 This fluid is derived largely by filtration from blood flowing through the
capillaries in the synovial membrane.
 Synovial fluid has a viscous, egg-white consistency due to hyaluronic acid
secreted by cells in the synovial membrane, but it thins and becomes less
viscous during joint activity.
 Synovial fluid, which is also found within the articular cartilages, provides a
slippery, weight-bearing film that reduces friction between the cartilages.
 Without this lubricant, rubbing would wear away joint surfaces and
excessive friction could overheat and destroy the joint tissues, essentially
“cooking” them.
 Synovial fluid also contains phagocytic cells that rid the joint cavity of
microbes and cellular debris.
5. Reinforcing ligaments.
 Synovial joints are reinforced and strengthened by a number of bandlike
ligaments.
 Most often, these are:
 capsular ligaments, which are thickened parts of the fibrous layer.
 In other cases, they remain distinct and are found outside the
capsule (as extracapsular ligaments) or deep to it (as
intracapsular ligaments
6. Nerves and blood vessels.
 Synovial joints are richly supplied with sensory nerve fibers that innervate
the capsule.
 Some of these fibers detect pain, as anyone who has suffered joint injury is
aware, but most monitor joint position and stretch.

Other Structural Features:

 Fatty pads
 are found in some synovial joints lying between the synovial membrane
and the fibrous capsule or bone. Examples are found in the hip and knee
joints.
 articular discs, or menisci
 
improve the fit between articulating bone ends, making the joint more
stable and minimizing wear and tear on the joint surfaces.
Bursae and Tendon Sheaths
 Bursae
 are flattened fibrous sacs lined with synovial membrane and containing a
thin film of synovial fluid.
 They occur where ligaments, muscles, skin, tendons, or bones rub
together.
 tendon sheath
 is essentially an elongated bursa that wraps completely around a tendon
subjected to friction, like a bun around a hot dog.
 They are common where several tendons are crowded together within
narrow canals (in the wrist region, for example).

Types of Synovial Joints

 Plane joints:
 In plane joints, the apposed articular surfaces are flat or almost flat, and this
permits the bones to slide on one another.
 Examples of these joints are the sternoclavicular and acromioclavicular joints
 Hinge joints:
 Hinge joints resemble the hinge on a door, so that flexion and extension
movements are possible.
 Examples of these joints are the elbow, knee, and ankle joints
 Pivot joints:
 In pivot joints, a central bony pivot is surrounded by a bony–ligamentous ring and
rotation is the only movement possible.
 The atlantoaxial and superior radioulnar joints are good examples.
 Condyloid joints:
 Condyloid joints have two distinct convex surfaces that articulate with two
concave surfaces.
 The movements of flexion, extension, abduction, and adduction are possible
together with a small amount of rotation.
 The metacarpophalangeal joints or knuckle joints are good examples
 Ellipsoid joints:
  In ellipsoid joints, an elliptical convex articular surface fits into an elliptical
concave Articular surface.
 The movements of flexion, extension, abduction, and adduction can take place,
but rotation is impossible.
 The wrist joint is a good example
 Saddle joints:
 In saddle joints, the articular surfaces are reciprocally concavoconvex and
resemble a saddle on a horse’s back.
 These joints permit flexion, extension, abduction, adduction, and rotation.
 The best example of this type of joint is the carpometacarpal joint of the thumb.
 Ball-and-socket joints:
 In ball-and-socket joints, a ballshaped head of one bone fits into a socketlike
concavity of another.
 This arrangement permits free movements, including flexion, extension,
abduction, adduction, medial rotation, lateral rotation, and circumduction.
 The shoulder and hip joints are good examples of this type of joint

V. Etiology

VI. Pathophysiology/Mechanism of Injury/Pathology

VII. Clinical Signs and Symptoms/ Physical Disabilities/ Impairments

VIII. Diagnostic Tools/ Procedures or Test

IX. Differential Diagnosis Conditions

X. Managements
  Pharmacological Management

 Medical and Surgical Management

 Physiotherapeutic management of pain

XI. REFFERENCES