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1
Chiro Science
Mid Term Exam
Dr. Peter M.Schoeb
Feb. 29, 1996 (Retyped 2.26.97)
Multiple Choice
Comparing the myofacial pain syndrome (MPS) with fibromyalgia syndrome
(FMS), the
MPS is of chronic nature- more than 3 months duration
MPS is common and the prevalence is 50% male and female
MPS produces generalized aching in the soft tissue
MPS is uncommon and the prevalence is 80% female
To assess trigger point (TP) the__________ is an objective sign found during
palpation ?
relaxed almost hypnotonic muscle around an active TP
the local twitch response reproducing the chief complaint
painful decreased ROM of the adjacent joint
visible elevation over the TP along with hyperemia
blunt trauma trauma with hemorrhage which caused the TP
According to Dr. Travell, TP’s are manifest in four stages. Which stage describes a
TP which is subacute and upon palpation, reproduces the chief complaint ?
A) 1
two
C) 3
D) 4
T / F Dr. Trevall’s treatment protocol for TP’s has the following sequence
Vapo - coolant spray procedureStretchHeatThree cycles of full ROM
T / F Dr. Nimmo’s Receptor Tonus Method suggests ischemic pressure on the TP of at
least 15-20 seconds ? (should be 5-7 sec.s)
2
Multiple Choice
The self feeding pain spasm pain cycle which
perpetuates the existence of a TP
may be successfully interrupted by which of the following procedures ?
Application of moist heat for 10-15 minutes depending on the area and the severity of the
TP
“Quick stretch” of the involved muscle tissue to normalize tone
Transverse friction massage of the Tp and the surrounding muscle tissue
An adjustment at the appropriate vertebral level along with ischemic compression of the
TP
Gentle mobilization of the involved soft tissue
T / F Postural Exam an ROM assessment are not necessary in the overall evaluation and
differential diagnosis of TP’s and the myofacial pain syndrome
Matching: Ddx.: TP’s vs. Tender points:
A. Tender points
B. Trigger points
A - Tender points
Primary fibromyalgia (Tender Point)
Pain in prescribed locations in multiple areas (Tender Point)
Localized tenderness without referral pattern (Tender Point)
B - Trigger Points
Found in belly and insertion of the traumatized muscles (Trigger Point)
Source of consistent referred myofacial pain (Trigger Point)
Myofacial Pain (Trigger Point)
T / F Excess calcium in the contractile elements of the muscle fibers may cause sustained
local muscle contractions
Multiple Choice
3
“Finger palpation” of a taught muscle band / TP is the correct palpatory procedure
for which of the following muscles ?
A)
B)
C)
D)
Erector Spinae
Supraspinatus
SCM
Rectus abdominus
Nimmo receptor tonus technique is best described as ?
Adjustment of the spinal level associated with the TP
Consistent vibratory pressure over the TP
Nerve compression in the area of the TP to break the pain spasm pain cycle
Application of static, constant pressure over the TP
The presence of a sleep disorder, by definition greater than 80%, is characteristic of
the following muscular condition ?
A)
B)
C)
D)
E)
Rheumatic myopathy
Myofacial pain syndrome
Myofascitis
Hypermyotonia
Primary fibromyalgia
The management of the myofacial pain syndrome would include the following ?
A) Adjustment, systemic light aerobic exercise, rest, reduced stress
B) Adjustment, stretching exercises, nutritional support and local treatment of
choice
C) Adjustment, heavy exercise, ice and interferential, local massage
D) A&B
E) A&C
T / F Skin and scar trigger points are mostly dormant, do not cause any discomfort and
referred pain patterns are rarely present
T / F Referred pain upon pressure on a Trigger point is a hallmark of the myofacial pain
syndrome and indicates the presence of a Trigger Point.
Fill in the Blank
Name the five biomechanical and/or anatomical causes of myofacial pain:
(each correct answer is worth one point)
4
1)
2
3)
4)
5)
Nutrition
Metabolic
Endocrine
Systemic Perpetuating Diseases
Psychological factors
(This was transcribed as was …answers have not been verified 2.26.97)
Good Luck !
More Stuff for Schoeby One Kanoby (Hand Written Notes In Library)
Strain & counter Stain
Manual Therapy Technique
Places joint passively in the position of greatest comfort in order to relieve pain in order
to relieve pain
Eliminates inappropriate proprioceptor activity that perpetuates somatic or neuromuscular
dysfunction.
Decreases hyperactive myoitonic reflex arc (afferent gain originating from muscle
spindle.
Usually with in the same segment)
Decreases approximation of relaxed joint surfaces and thus allows increase of ROM and
joint mobility.
Decreases muscle spasm of muscles surrounding affected joints
Myofacial Pain and Dysfunction
Taught band in muscle
Trigger point
4 stages (Travell)
I. Acute, constant pain
II. Sub acute, reproduces chief complaint
III. Local pain upon plpation
IV. No trigger points at all
5
Palpation: Local Twitch Response
LTR = Objective sign reprodicing Chief complaint
Assesment:
1. ROM
2. Postural Exam
3. Palpation of muscle Trigger Point (s) thru progessive Soft Tissue Levels
Non-Myofascial Trigger Points
( trigger point types )
1. Skin / Scar
2. Fascial and Ligamentous
3. Periosteal
A. Accupuncture & Trigger Points
B. Motor Points vs. Trigger Points
Musculoskeletal Diseases
Rheumatoid Arthritis
Dermamyositis
Osteoarthritis
Gouty Arthritis
Polymyositis
Psoriatic Arthritis
Neurologic Diseases
Psycogenic Pain and Pain Behavior
Neoplasms
Neuralgias : (Neck Musculature)
Tortacolis
Infection
Trigeminal Neuralgia ( aka Tic DeLarue)
6
Causes of Myofacial Pain
Metabolic
Endocrine
Nutritionnal
Systemic Perpetuating Diseases
Psycological Factors
Also…
Ergonomic (factors)
Long 2nd Meta Tarsal (&)
Short
1. Upper Arm
2. Hemi Pelvis
3. Leg
Treatment
Postural Corrections
1. Heel Lifts
2. Arch Supports
3. Ischial Lifts
Vapocoolant Spray Proceedure
1. 45 cm/18 inches (30 degree Angle)
2. Stretch (Passive & Full ROM)
3. Heat (Moist)
4. 3 Cycles of Full ROM
Ergonomic Consideration
1. Car Seat
2. Chair Size
3. Ischial Lift
4. Support (Low Back)
5. Work Station
a. Height
b. Distance from Work Station = “the lever”
6. Chair
7
Back rest: Should Cover Inf. Angle of Scapula (stabilizes Shoulder Joint Muscles)