Skip to main content
SpringerLink
Log in

Mechanismen des Muskelschmerzes

Bedeutung von Trigger points und Tender points

Mechanisms of muscle pain

Significance of trigger points and tender points

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Das Fibromyalgiesyndrom (FMS) und das myofasziale Schmerzsyndrom („myofascial pain syndrome“, MPS) sind die bekanntesten Vertreter der Gruppe der chronischen nichtentzündlichen Schmerzen im Bereich der Muskulatur und Sehnenübergänge. Wichtige Kriterien in der Diagnose dieser Erkrankungen sind dabei die „tender points“ und die „trigger points“. Während Tender points, entsprechend den ACR-Kriterien, unbedingt für die Diagnose eines FMS notwendig sind, sind die Trigger points das typische Zeichen des MPS.

Ein wesentlicher Unterschied besteht darin, dass Tender points bisher nur durch ihre Lokalisation definiert werden konnten, während Trigger points durch Palpation ertastet werden können und auf Reizung mit einer lokalisierten Schmerzreaktion antworten können. Weiter zeigten Untersuchungen mittels Mikrodialyse, dass diese Punkte eine erhöhte Konzentration an schmerzvermittelten Substanzen besitzen. Darüber hinaus spielen Trigger points im Gegensatz zu Tender points in der Therapie als Ziel lokaler manueller oder medikamentöser Interventionen eine große Rolle in der Beseitigung der Beschwerden.

Abstract

Fibromyalgia syndrome (FMS) and myofascial pain syndrome (MPS) belong to the group of chronic non-inflammatory pain syndromes affecting muscles and tendinous insertions. Important criteria in the diagnosis of both diseases are the presence of “tender points” and “trigger points”. According to ACR criteria FMS is characterized by the presence of tender points whereas trigger points are typically found in MPS.

The main difference is that until now tender points could only be defined in terms of their localization, whereas trigger points can be found upon palpation which may cause a specific referred pain pattern. In addition, analysis of trigger points by microdialysis demonstrated elevated levels of pro-inflammatory substances at these sites. Moreover, local treatment of trigger points either by manipulative therapy or injection appears to be most effective for prompt relief of symptoms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Wolfe F, Smythe HA, Yunus MB et al. (1990) The American College of Rheumatology 1990 Criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 33: 160–172

    Article  PubMed  CAS  Google Scholar 

  2. Reynolds MD (1983) The development of the concept of fibrositis. J Hist Med Allied Sci 38: 5–35

    Article  PubMed  CAS  Google Scholar 

  3. Borg-Stein J, Stein J (1996) Trigger points and tender points: one and the same? Does injection treatment help? Rheum Dis Clin North Am 22: 305–322

    Article  PubMed  CAS  Google Scholar 

  4. Croft P, Schollum J, Silman A (1994) Population study of tender point counts and pain as evidence of fibromyalgia. BMJ 309: 696–699

    PubMed  CAS  Google Scholar 

  5. Gupta A, McBeth J, Macfarlane GJ et al. (2007) Pressure pain thresholds and tender point counts as predictors of new chronic widespread pain in somatising subjects. Ann Rheum Dis 66: 517–521

    Article  PubMed  CAS  Google Scholar 

  6. Eich W, Hauser W, Friedel E et al. (2008) Definition, classification and diagnosis of fibromyalgia syndrome. Schmerz 22: 255–266

    Article  PubMed  CAS  Google Scholar 

  7. Travell JG (1951) Pain mechanisms in connective tissues. In: Ragan C (ed) Connective tissues: transactions of the second conference. New York, p 86–124

  8. Cummings M, Baldry P (2007) Regional myofascial pain: diagnosis and management. Best Pract Res Clin Rheumatol 21: 367–387

    Article  PubMed  Google Scholar 

  9. Lavelle ED, Lavelle W, Smith HS (2007) Myofascial trigger points. Med Clin North Am 91: 229–239

    Article  PubMed  Google Scholar 

  10. De Stefano R, Selvi E, Villanova M et al. (2000) Image analysis quantification of substance P immunoreactivity in the trapezius muscle of patients with fibromyalgia and myofascial pain syndrome. J Rheumatol 27: 2906–2910

    Google Scholar 

  11. Shah JP, Phillips TM, Danoff JV, Gerber LH (2005) An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol 99: 1977–1984

    Article  PubMed  CAS  Google Scholar 

  12. Shah JP (2008) Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis. J Musculoskeletal Pain 16: 17–20

    Article  Google Scholar 

  13. Hubbard DR, Berkoff GM (1993) Myofascial trigger points show spontaneous needle EMG activity. Spine 18: 1803–1807

    Article  PubMed  CAS  Google Scholar 

  14. Simons D (1994) Single-muscle myofascial pain syndromes, 2nd ed. Williams & Wilkins, Baltimore/MD

  15. Wolfe F, Simons DG, Fricton J et al. (1992) The fibromyalgia and myofascial pain syndromes: a preliminary study of tender points and trigger points in persons with fibromyalgia, myofascial pain syndrome and no disease. J Rheumatol 19: 944–951

    PubMed  CAS  Google Scholar 

  16. Gerwin RD, Shannon S, Hong CZ et al. (1997) Interrater reliability in myofascial trigger point examination. Pain 69: 65–73

    Article  PubMed  CAS  Google Scholar 

  17. Myburgh C, Larsen AH, Hartvigsen J (2008) A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil 89: 1169–1176

    Article  PubMed  Google Scholar 

  18. Goldenberg D (1989) Diagnostic and therapeutic challenges of fibromyalgia. Hosp Pract (Off Ed) 24: 39–52

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinische Abteilung für Rheumatologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Auenbruggerplatz 15, 8036, Graz, Österreich

    H.-P. Brezinschek

Authors
  1. H.-P. Brezinschek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.-P. Brezinschek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brezinschek, HP. Mechanismen des Muskelschmerzes. Z. Rheumatol. 67, 653–657 (2008). https://doi.org/10.1007/s00393-008-0353-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-008-0353-y

Schlüsselwörter

Keywords

Search

Navigation