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57(lwl) 173-181)
1 1W-1 Fl\evier Science L3.V. ,\I1 right5 reserved 0303-3Y5Y~94jXOi OC

Chronic pain after soft-tissue injury of the cervical spine: trapezius

muscle blood flow and electromyography at static loads and fatigue

Summary Microcirculation in the upper portion of the right and left trapczius muscles was measured
percutaneously by laser-doppler tlowmetry (LDF) during two IO-min-long series of alternating I-min periods ot
static contraction and rest determined electromyographically (EMG). Twenty-five patients with pain persisting after
a soft-tissue injury of the neck were studied. Pain assessments by using visual analogue scales and drawings showed
13 patients with predominantly unilateral and 12 with bilateral neck-shoulder pain. in some cases with arm pain and
numbness. Mean age was 41 (23-58) and 39 (22-54) years and a female/male ratio X: 5 and IO: 7. respectively.
Stepwisc increased contraction was induced by keeping straight arms at 30”, hO”. 90” and 135” of elevation. and
repeated with a 1 kg (women) or 2 kg (men) hand loads. Signal processing was done on-line by using a 3XhSX
computer. LDF and EMG values were normalized. Spectral shift of EMG mean power frequency (MPF) for fatigue
was analyzed. Muscle blood flow on the “normal” side in the unilateral pain group showed an ordinary increase at
increased angle of arm elevation, shoulder torque and EMG amplitude. On the painful side, during increased
muscle tension and fatigue, the ability to increase blood flow appeared to bc impaired, and there was no consistent
increase in either side of the bilateral pain group. EMG amplitude showed a significant positive correlation to the
angle of arm elevation and shoulder torque. The rms-EMG (root mean squared EMG) increase was lower in the
painful side at high force contraction (non-normalized data). MPF showed a significant fall at increasing torque. and
the endurance time was reduced. The results suggest a disturbed regulation of the microcirculation of the upper
trapezius muscle. Chronic trapezius myalgia may be a prominent and important feature for maintenance of this
common pain syndrome.

Key words: Electromyography; Laser-doppler; Muscle blood flow; Pain: Trapczius muscle: Whiplash injury

Introduction tally, neck stiffness and muscle tenderness are often

the only symptoms. By using conventional laser-dop-
“Soft-tissue injury” of the cervical spine may be pler techniques, we have shown impaired muscle blood
used to refer to whiplash, hyperextension, acceleration flow in female assembly workers with local pain in the
injury and cervical strain and is most often caused by upper trapezius muscle (chronic trapezius myalgia)
motor vehicle collisions, especially rear-end collisions persisting despite long-term absence from work (Lars-
(Hohl 1989). Major complaints are neck-shoulder pain son et al. 1990). In addition, the painful muscle showed
and headache which may become persistent in many a discrete disturbance of the mitochondria in type I
patients. Objective signs of organic injury arc rare and fibers, probably resulting from locally impaired blood
the etiology of the pain is unknown. This makes evalu- flow. Disturbed regulation of the microcirculation might
ation and treatment of these patients difficult. Clini- be an important factor in persisting. more or less
autonomous, pain conditions. This has been a hypothc-
sis of the present investigation. Laser-doppler flowme-
* Corrr.rl,o~~tlrnl: cruthor: Sven-Erik Larsson, Department of Or- try (LDF) was introduced by Stern in 1975 and first
thopaedic?. University Hospital. S-581 X5 Linkiiping. Sweden. applied to skeletal muscle by 6berg ct al. (lY7Y). In

SSI)I 0305-3YiY(Y3)EO100-J
I 7-J
clinical research, we (Larsson et al. t993aI have rc-
cently presented a technique for percutane~)us mea-
surements of the microcircuIation in skeletal muscle at
varying degrees of static load determined electromyo-
graphically (EMG). Dynamic measurements were per-
formed by using optical single fibers, a technique de-
veloped by Salerud and aberg (1987). Computerized
signal processing was done on-line.
In the present study, we report on bilateral record-
ings of the microcirculation and EMG in the upper
portion of the trapezius muscle during varying levels of
static contraction with development of fatigue in a
consecutive series of 25 patients with chronic neck pain
persisting after a history of whiplash injury.
Materials and methods
Patients
The study included 25 patients (18 women and 7 men). Mean age
was 40 years (22-58), mean body height 168 cm (154-181) and mean
body mass 71 kg (50-95). The patients had been referred to the
orthopedic out-patient ward because of chronic neck pain persisting
3-108 months after trauma sustained at car collision. A typical
rear-end collision was reported by 11 patients, a front-to-front colli-
sion by 13, and a side collision by 1. All patients underwent a
thorough physical examination with regard to the pain condition.
This was assessed by the patient who used a visual analogue scale
(VAS) graded O-10 and, in addition, marked the location of pain and
any sensory disturbance on standard anatomical figures. Physiother-
apy, anaigetics and sick-leave had no lasting effect. The majority of
patients had recieved a soft collar and were re~mmended early
mobilisation. Ten of the 25 patients were habitual smokers with
moderate cigarette consumption. None had any medication therapy
that could influence the outcome of the study, i.e., medication for
hypertension. informed agreement to participate in the study was
given by all patients. Consent to the study was given by the Research
Ethics Committee at our hospital.
Exposure to static load
The right and left trapezius muscles were simultaneously exposed
to stepwise increased static load for periods of 1 min each with 1 min
of rest in between. The patient was sitting upright in a standard
office chair with relaxed, hanging arms (rest position). On command,
the patient raised straight arms symmetrically in the scapular plane
~approximately midway between abduction and flexion) to subse-
quentiy 30”, 60”, 90” and 135”, i.e., the load positions. This was then
repeated with a 1 kg (women) or 2 kg (men) load carried in each
hand. Finally, a fatigue test was performed with straight arms ele-
vated at 45” holding a hand foad. Recovery was then achieved with
hanging arms and no hand load, LDF and EMG signals were
recorded continuously during the three lo-min tests. The torque in
the shoulder joint was calculated by standard biomechanical meth-
ods. The computations were based upon the individual height and
weight of the person as described by Chaffin and Andersson (1984)
and the weight and center of mass of the arm according to Le Veau
(1977).
Laser-doppler jlowmetry
LDF was used for simultaneous measurements of the microcircu-
lation in the upper portion of the right and left trapezius muscles, as
we have described in detai? previously (Larsson et al. 1993a). The
optical hmgle fibers used (Salerud and Oberg ili~i:j h;td %iii~;trnzrcr
ol’O.5 mm and were placed p~rcut~~~l~ouslywithin ihc mu~lc hiclfw,:\
hetween the spinous process of rht: (7 vertehr:t ,imi thc ;icromiorr
insertion was made via a plastic cannula (Venflnn :Zi.v cunnula. i.i,
mm outer diameter. Viggo, fielsingborg, Swcdcn 1 th,%t h;td i;ec~l
inserted into the muscle to Icad the optical fihrr to the maxrnlill
depth for the recordings. i.t... .S- IO mm from ILL’point whcrc the
subject noticed the somewhat painful passage of the cannuia Ihrough
the muscle Fascia. A laser-doppler flowmeter (modified Periflux, Pfld
Perimed, Stockholm, Sweden) was used for the measurements (time
constant: 0.2 set: 4 kHz. gain 1). ,411determinatilm\ were purformcd
in a quiet laboratory room and :tt ;I tcmperaturi’ rrl 20.- 21°C‘.
EMG
EMG was recorded simultaneously with LDF by using bipolar
surface electrodes (Medicotest pre-gelled child KG-electrodes),
placed over the right and left trapezius muscle halfway between the
ipinous process of the C7 vertebra and the acromiort. The center-tct-
center inter-electrode distance was 2.0 cm. The reference electrode
was placed over the spinous process of C?. t3MC signals were
visualized on an oscilloscope for testing electrode function.
Signal processing
The experimental set-up was similar to that used in our previous
study (Larsson et al. 1993a). LDF and EMG signals were converted
into digital form in an A/D converter (AT-MIO-16, National Instru-
ments, USA) with a resolution of 12 bits and processed on-line by
computer (Intel 386SX/20 MHz processor, 140 MB hard disc). Fast
Fourier transform was performed using Lab-Windows program. Root
mean squared EMG (rms-EMG) as well as mean power frequency
(MPF) were calculated by using OS-set segments. For each 1-min
examination period we used 20 segments representing the 40-50
second part with exclusion of the first and the last segments to avoid
disturbances from sample processing. A total of 18,432 points were
used per measurement. LDF was calculated for each consecutive
I-min examination period by using the last 20 set of each period.
Before filtering, 2048 points/set were used.
Processing in a digital Butterworth tow-pass filter of 8th order
was used for a frequency range of O-8.2 Hz which corresponded to
the blood flow spectrum of interest. MPF was calculated according
to Rasmajian and DeLuca (1985).
Normalization of EMG and LDF
Normalization was performed to reduce the influence of distur-
bances during measurement and to facilitate comparison between
individuals. For LDF and rms-EMG all data were divided by the
mean of the different measurement values of each individual test
series, i.e., values recorded at an arm elevation of 0’ (rest), 30”. 60”.
90” and 135”. Normalization was not used for MPF.
statistical analyses
Regression analyses were performed according to Neter et al.
(1989). For graphic demonstration of results, which were significant
at testing by using ail individual vafues, linear regression of group
mean values and paired f tests were used (Snedecor and Cochran
1967). P < 0.05 was considered significant.
Results
Patients
Predominantly unilateral pain ( < 3 VAS points in
the “normal” side) was reported by 13 patients (8
women and 5 men), while bilateral pain was reported
by 12 patients (10 women and 2 men). Mean side widespread pain, tenderness or other symptoms char-
difference for the unilateral pain group was 5.2 (2.5- acteristic of the fibromyalgia syndrome.
8.0) on VAS. The painful side had a mean value of 6.3 Plain radiographs showed ordinary findings. Eight
(2.5-8.5) and the normal side 1.1 (o-3.0). For the cases also had brachialgia and underwent magnetic
bilateral pain group, a mean difference of 0.Y was resonance imaging (MRI) of the cervical spine. One of
recorded between the most and least painful sides, 2 cases with constant segmental brachialgia showed
showing means of 6.2 and 5.3. Mean age for both disc protrusions (C4-C5 and CS-C6) and unilateral
patient groups was 41 years (23-58) and 39 years foraminal encroachments; I of 2 cases with intermit-
(22-54) with a symptom duration of 36 months (3-10X) tent segmental brachialgia had slight disc protrusions
and 40 months (3-79). Onset of pain directly after the (C4-CS. CS-C6 and C6-C7). Four patients with diffuse
accident was reported by 21 patients and onset from 1 brachialgia showed slight to moderate disc protrusions
day to 10 weeks by the remaining 4 patients. Most (C3-C4, CS-C6 or C6-C7), in 1 case with unilateral
patients reported continuous local pain of a dull char- foraminal encroachment (C5-CO). Only 1 patient was
acter as well as neck stiffness. Pain location was similar considered for surgery.
in the majority of patients being the upper trapezius-
shoulder region, in some also involving the arm with Puirz rwction und endurunce time
numbness in the ulnar region. Clinical examination All patients experienced exaggerated pain and fa-
revealed a slight-to-moderate limitation of active neck tigue in the region of the affected muscle(s) during the
motion range in one or more planes in all patients, series of stepwise increased contractions and often
showing no striking differences between cases with uni- numbness of the arms. However, no one had to break
and bilateral pain. Most patients showed tenderness off from the trial. Endurance time walr shorter for the
over the painful trapezius muscles. Disturbed night subjects in this study as compared with healthy women
sleep was frequent. None of the patients had and men studied previously (Larsson et al. lYO3b,c).

Normal side Pain side

EMG 0 kg EMG 0 kg

LDF 0 kg

EMG 1 kg

LDF 1 kg LDF 1 kg

0 1 2 3 4 S 6 7 8 9 10 012345678 9 10

Minutes Minutes
Fig. I. Continuous recordings of LDF and rms-EMG during alternating I-min periods ot rcs;t and stepwise increased static contractions at varying
degrees of arm elevation and repeated with a hand load. Motion artefacts in LDF are seen during raising and lowering of the arm\ at the
beginning and end of each examination prrwd. LDF was measured during the last 20 set of each I-rntn pcrlod.
I 70

‘I’aken together, all women with pain had an endurance results of significance testing ot the 401~ ot the rcgrc>
time of 2.V min (SD. = 0.X3) as compared to 4.3 min sion line based upon individual dal,l xc shown 111
(SD. = 1.20) for the healthy women (P < 0.001 ). The Table 1. The squared Pearson corrclatlon coefficient
corresponding values for men were 3.4 min (S.D. = (r’) was relatively large for normalixd EM(I vcrsu>
0.53) and 3.8 min (SD. = 0.56) (1’= O.06). angle of arm elevation and versus calculated shouldcl
torque. In comparison, LDF showed smalkr r’ Vi~lucs.
LDF‘ und EMG signuls indicating larger variability of LDF than of EMG.
Processed LDF and EMG recordings from I of our Normalized EMG increased significantly with the
patients arc shown in Fig. 1. rms-EMG shows stepwise angle of arm elevation and increased shoulder torque
increased levels during the periods of 0”. 30”, 60”, 90 in all the patients (Table I). No obvious differences
and 135” of arm elevation and even more so when were found between the pain and ‘,normal” sides.
repeated with added hand load. The interposed 1-min However, when unnormalized data were analyzed, sig-
rest periods show very low EMG activity. LDF, nificantly lower rms-EMG was found in the painful
recorded simultaneously, shows high peaks at the be- side compared to the “normal” side tor high-force
ginning and end of each load period. These were contractions (90” and 135” of arm clecation both with
motion artefacts caused by raising and lowering of the and without hand load). LDF showed quite a differ-
arms, most probably by internal tissue motion other ence between the “normal” and painful sides in the
than blood flow. The painful side shows somewhat unilateral pain group. Thus. muscle blood flow in-
lower LDF levels during contractions compared to the creased significantly in the “normal” side in relation to
“normal” side. There is no difference as regards rms- increased angle of arm elevation, shoulder torque and
EMG. EMG, while in the painful side no significant changes
LDF recordings also show the phenomenon called occurred. As demonstrated graphically. patients with
“vasomotion”, i.e.. rhythmical variations with ;I fre- unilateral pain showed a significant increase in muscle
quency of S-6 cyclcs/min. These indicate that no blood flow in the “normal” side with increased angle
disturbance to the microcirculation was caused by the of arm elevation (Fig. 2), increased shoulder torque
intramuscular LDF probe. (Fig. 3) and increased normalized EMG (Fig. 41, which
is in accordance with our results obtained in hcalthq
IBF and EMG in relation IO static loud subjects (Larsson et al. 1993b,c). In Ihc painful hi&
Changes in LDF and normalized EMG during the there was only an initial increase that ~a\ followed by
course of stepwisc increased static contractidns were a decline towards the base level. Comparison between
subjected to regression analyses. Multiple regressions groups using non-normalized data gave no further in-
showed best correlations between LDF and EMG. The formation. The bilateral pain group showed incon&

TABLE I
SIGNIFICANCE TESTING OF THE SLOPE OF THE REGRESSION LINE BASED UPON INDIVIDUAL DATA

Cateporq Bilateral pain group Unilateral pain group

Left side Right side Normal side Pain side

EMG VS. angle

0 kg 1 ; 9.837 sign I = 1 0.347 sign r = Y.489 sign I = h.OY7 sign
rz = 0.617 1.2 = 0.641 rz = 0.581 r 1 = 0.408
I or2 kg I = 12.296 sign i = I I.696 stgn I = 13.536 sign I = 10.771 sign
r.’ = 0.716 r ’ = 0.695 rz = 0.738 r’ = 0.641
EMG vs. lorque I = X.872 sign t - Y.743 sign I = 9.519 sign I -= 1I.047 Qyl
r 2 = 0.396 , 2 ==0.141 r‘ = 0.411 )‘? = 0.481
LDF \c. angle
0 kg t = 4.590 sign / = O.OYY n.\ I ==2.361 sign I = O.OY5
n.5.
r’ = 0.260 r 2 = 0.0002 r I = 0.079 r ’ = O.o(JOl
1 or 2 kg I .= 0.020 ns. f = 2.708 sign I = 2.967 sign I = 0,136 n.s.
r? = 0.000006 r .! = 0. IOU r:=o.119 r ’ = 0.000.3

LDF vb. torque t .= 1.097 n.s. I = 0.630 n.r. t = 2.024 sign I ; 0.176 ,L\.
rL = O.Ol(l r J -; 0.003 I> = 0.031 r 2 -=- 0.0002

LDF v)r. EMG I = 2.623 sign I := 0.103 n.\. 1 = 1.835 sign I ==1.317 ,I.\
r 2 = 0.054 I? ; O.OOOYY rz = 0.058 r’ = 0.01 7

LDF vs. MPF / = 1.286 n.s. I = 1.960 biyn 1 = 1.408 sign ’ I = I.144 11.4.
r? = 0.017 r 2 = 0.039 r’ = 0.019 r’= 0.012

’ Almost sign.
 Normal Stde Pain Side

Normal Side Pam Side

0 kg
LDF
*
tent significant changes (Table I); in thl: left side LDF
showed an increaxc at increased angle of arm elevation
with no hand load and also an incrence with increased
EMG. In the right side an increase of LDF was tbund
only with incrcascd angle of arm elevation with added
1 EMG
hand load. )\I1 our patients wcrc right-handed.
2 2
The ovcr;tll rcsrtlts Ior the patients with ui~il~~t~r~i~
pain arcs shown in Fig. 5. A ~~~rnp~ris~n between single
1 1
pairs of groups as regards individual LDF valucc
showed significantly lcjwtx normalized values on the 0 0

> 3
------__
Normal Side Pain Side
_--,y,21 LDF

T-T 2
LDF

I
‘0
T,
t
1 or
t
2 kg

J0 R-O 57 R=0.14 .’ (I
I I I
1

0
 -- --__-___. ___ __~____
__...
Normal Side Pain Side - Normal Side Pawn Side
: I

R=-0.72
I R=-0.72
I ,
‘-- 1

0 10 20 iI 1 :, 2”

TORQUE (Nm)

Fig. 7. EMG mean power frequency (MPF) in relation to shoulder

torque in the same group of patients as in Figs. 2-h. There was a
significant fall in MPF with increased torque. We were not able to
0 SO 100 IS0 0 50 100 150 demonstrate any difference between the painful and the “normal”
side.
Arm elevation degrees

Fig. 6. Normalized EMG in relation to shoulder angle at arm in healthy subjects (Larsson et al. 1993b,c). The painful
elevation without and with a hand load, calculated for patients with
side showed no significant change. Further, patients
unilateral neck-shoulder pain. A paired t test showed 2 group values
being higher in the painful side than in the “normal” side (* above
with bilateral pain showed no significant increase in
the respective group). There were no significant differences, other- any side (r = -0.16 and 0.11).
wise.
LDF during the endurance test
Measurements were performed once during the ini-
pain side than one the “normal” side at high-force tial rest position and thereafter each minute (2-4) of
contraction. As shown graphically in Fig. 6, normalized maintained elevation of the arms at an angle of 45”
EMG showed a significant increase with increased arm with the added hand load of 1 kg (women) or 2 kg
elevation and also with increased shoulder torque, in (men). The values for blood flow measurements ob-
conformity with the results of healthy subjects reported tained during the sustained contraction were too few to
previously (Larsson et al. 1993b,c). The highest values allow more detailed analysis.
of EMG obtained at 135” of elevation were certainly
due to shortening of the muscle that is necessary for
rotation of the scapula for this position of the arm. Discussion
There were no consistent differences between the two
sides in any of the patient groups. Patients with unilat- Dynamic recordings of the blood flow and EMG
eral pain showed increased EMG on the painful side in were performed simultaneously in the right and left
only two recordings: at arm elevation against gravity to
60” and at elevation to 30” with hand load, but other- 2s 75
Normal Side Pain Side
wise no side difference. ,
R-0.50 R--0.05 *
i0
I I
MPF in relation to shoulder torque
As shown graphically in Fig. 7, MPF diminished
with increasing torque as a sign of accumulated local
fatigue during stepwise increased .elevation of the arms,
in conformity with our results obtained in healthy
subjects (Larsson et al. 1993b,c). No differences were
found between the two sides in unilateral or bilateral
pain groups (r = -0.83 and -0.91). Healthy men and
women showed a somewhat less pronounced fall in 0 1.,--.---l 0
1 so 100 50 15" IO0 50
MPF (Larsson et al. 1993b,c).
MPF (Hz)

LDF in relation to MPF Fig. 8. Normalized LDF in relation to MPF in the unilateral pain
group (Figs. 2-7). LDF showed a significant, ordinary increase with a
The patients with unilateral pain showed in the fall in MPF in the “normal” side but not in the painful side. This
“normal” side a significant increase in LDF with a fall showed 3 group values that were significantly lower (* below the
in MPF (Fig. S), in agreement with our results obtained groups) and one that was higher (* above the group).
trapezius muscles, by using the technique which WC microcirculation in the trapezius muscle is a normal
have described previously (Larsson et al. 1993a). Com- response at increased contraction levels (Larsson et al.
puterized signal processing was performed on-line 1993b,c). The same external work was done on the
which appeared to be a necessity for doing these types painful and the “normal” side, and the two showed no
of measurements. A relatively large variability was en- differences as regards the normalized EMG activity
countered. This was mainly caused by different biologi- rccordcd during load as well as rest. However, analysis
cal factors which appeared to be involved in regulation of non-normalized data indicated a lower activation in
of the microcirculation in skeletal muscle. One factor the painful side at high-force contractions, probably
was certainly the spatial heterogeneity of blood flow due to pain inhibition. These results are in accordance
and flow reserve that is common in striated muscle with the report by 6berg et al. ( 1992) on unilateral
(Hargreaves et al. 1990). Our measurements included a chronic trapezius myalgia. The EMG amplitude (rms-
hemisphere of the tissue with a radius of about 1 mm. EMG) is generally considered to be a measure of the
This admitted measurements of representative samples prevailing muscle tension. Our patient recorciings gave
of the microvascular tree. Spatial heterogeneity might no evidence of increased neural excitability wnich has
nevertheless cause variability of the results, depending been suggested to prolongate acute pain leading to
upon varying vicinity of a larger vessel to the measuring chronic pain conditions (Wall 1989). Another hypothe-
probe. Examinations of more than 10 subjects at S-10 sis presented recently by Johansson and Sojka (IWI),
different test levels were necessary for calculation of implies that stiffness regulation via the fusimotor-spin-
the results by using regression of the recorded data and dle system may be an important factor in occupational
correlation analyses. The normalization of data used pain syndromes. They argue that metabolites produced
was found to reduce variability. by muscle contractions, i.c.. static contractions during
Laser-doppler techniques are sensitive to distur- monotonous work, stimulate group Ill and IV muscle
banzzs. i.e., from “motion artefacts” which arc caused afferents that will activate static and dynamic gamma-
by internal tissue movement that may be transferred to motoneurons projecting to both homonymous and het-
the optical fiber (cf., Shephard and 6berg 1990). These eronymous muscles with resulting enhanced rcflex-
did not affect the results of the present study. The mediated stiffness of the muscles. WC received no
experimental set-up used was closely examined in a evidence to support this theory.
previous study (Larsson et al. 1993a) by analyzing the The observed disturbance of the regulation c)f the
LDF power spectral density during low (muscle rest) local microcirculation might be a prominent feature of
and high (high-force muscle contraction) muscle perfu- this kind of persisting pain and might also explain the
sion. No disturbances were recorded from doppler-sig- self-generating character of the condition. Accumu-
nals generated by internal tissue motion other than lated local fatigue was indicated by the observed fall in
blood flow. the EMG mean power frequency although a side dif-
Despite the absence of objective clinical findings, all ference could not be recorded, probably due to the
the patients complained of persisting neck-shoulder large variability between individuals. This decrease is
pain of a severity that interfered with work. In this supposed to bc caused b) a lowered pH due to xxu-
condition, test abnormalities have been reported as eye mulation of lactate. At the cellular Icvcl. fatigue ot
motility dysfunction and trigeminal sensory impairment extremity muscles has been found to coincide with ;I
being suggestive of brain-stem dysfunction (Hildings- loss of potassium ions from the intracellular to cxtra-
son et al. 1989; Knibestiil et al. lY90). Alternatively, cellular space, causing reduction of the resting mem-
these discrete sensations could be due to disturbed brane potential (SjQgaard 196%). These metabolic
signal treatment caused by the continuous input of changes might well explain the occurrcncc of local
pain signals from neck receptors via axons of the upper pain. This might cause further disturbance of the mi-
cervical medulla. So far, the pathologic mechanisms of crocirculation in a vicious circle.
the persisting pain are unknown. All our patients re- Microcirculation in skeletal muscle is influcnccd by
ferred their pain to the trapezius muscle(s) preferen- a number of regulating factors, both local and distant
tially, in a I‘ew cases with additional pain and numbness regulators. One local factor is the intramuscular pres-
in the arm. These cases were too few to be analyzed sure which might impede blood flow during high-force
separately. Neurological signs were absent, however. contraction. However. relatively low prcssurc has been
Occipital headache radiating towards the eyes was reported for the trapezius muscle. seldom exceeding 50
common. mm Hg at varying angles of arm elevation (J%rvh~~lm et
Our results indicated an impaired regulation of the al. 1991). Our results in healthy persons (Larsson et at.
microcirculation in the painful trapezius muscle(s) 1993b.c) arc compatible with those findings. Other
which showed a decreased ability to increase the blood local factors are the sensory nerves which in addition
flow above a certain level during stepwise increased to transmitting nerve impulses to the central nervous
static contractions. In healthy persons, an increased system also sccrctc neuropt’ptides from their pcriph-
 IX0

era1 nerve endings. Several neuropeptides like CGKP Jarvholm, U., Palmerud, G., Karl&son, I)., tlert>rrts. I’ and k;~&-
(calcitonin gene-related peptide) and SP (substance P) fors, R., Intramuscular pressure and electiomyography ln four
shoulder muscles. J. Orthop. Res.. Y (IYY 1) fW 6lY.
are potential vasodilatators (Gazelius et al. 1985; Per- Knibest61, M., Hildingsson. C. and Toolanen, (; 1 I rigeminal \cnhot\
now, B. 1983) while others like NPY (neuropeptide Y) impairment after soft-tissue injury of the c<:r\+al spine. Act.1
are strong vasoconstrictors (Pernow, J. et al. 1987). Neural. Stand.. 82 (1990) 2-Y.
Continuous inflow of pain signals might cause a distur- Larsson, S.-E., Bodegird, L., Henriksson, K.G. and Oberg, P.A..
bance of these factors which are involved in transmit- Chronic trapezius myalgia. Morphology and blood flow studied in
17 patients. Acta Orthop. Scan&, hl (1990) 3Yj 398.
tance of pain, and influence regulation of the microcir-
Larsson, S-E.. Cai, H. and dberg, P..&, Continuous pcrcutaneouh
culation in the local muscle. measurement by laser-doppler flowmetry of sheletal muscle mi-
In conclusion, this series of patients with post- crocirculation at varying levels of contraction force determined
traumatic chronic neck pain showed a pain-related electromyographically. Eur. J. Appl. Physiol.. Oh t 1993a) 477-482.
decreased ability to achieve a normal increase of blood Larsson, S.-E., Cai, H. and bberg. P.,&, Microcirculation m the
upper trapezius muscle during varying levels of static contraction.
flow in the trapezius muscle(s) during stepwise in- fatigue and recovery in healthy women. A study using prrcuta-
creased static contractions. Development of chronic neous laser-doppler tlowmetq and surface electromyography.
trapezius myalgia with a disturbance of the regulation Eur. J. Appl. Physiol., 66 (19Y3b) 483-48X.
of muscle microcirculation might be a mechanism for Larsson. S.-E.. Cai, H. and Gbrrg. P.& Microctrculation in the
maintenance of this kind of chronic neck pain. upper trapezius muscle during varying levels of static contraction.
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