Zusammenfassung
Fragestellung
Myofasziale Triggerpunkte (MTrPs) sind druckempfindliche Stellen im Skelettmuskel, die im Verlauf von palpierbaren verspannten Muskelfaserbündeln (taut bands) liegen. In der Arbeit werden die Entstehung, Diagnose und Therapie diskutiert.
Methodik
Die vorgestellten Befunde beruhen teils auf Experimenten an narkotisierten Kaninchen, teils sind sie das Ergebnis einer jahrzehntelangen Erfahrung mit der Behandlung von Patienten.
Diagnose
Die genaue Diagnose erfordert eine hochentwickelte Fähigkeit zur manuellen Untersuchung der Muskulatur. Diese Fähigkeit kann durch Training und klinische Erfahrung verbessert werden.
Therapie
Manuelle Techniken, die der Patient selbst lernen kann, werden der trockenen Nadelung und der Injektionstherapie vorgezogen.
Schlussfolgerungen
Die integrierte Hypothese der MTrP-Entstehung bietet eine Zusammenfassung aller beteiligten Mechanismen und beruht größtenteils auf etablierten pathopyhsiologischen Mechanismen.
Abstract
Aim
Myofascial trigger points (MTrPs) are hyperirritable tender spots in palpable tense bands of skeletal muscle. Muscle is an orphan organ, no medical specialty claims muscle as its organ. The article aims at filling some of the gaps in the current knowledge of MTrPs.
Methods
The presented findings were partly obtained in experiments on anesthetised rabbits, partly they are the result of ample experience with patients suffering from MTrPs.
Diagnosis
Each muscle has a characteristic elicited referred pain pattern that, for active MTrPs, is familiar to the patient. Without a laboratory test or imaging method, diagnosis of MTrPs depends entirely on history and physical examination. MTrP symptoms follow muscle overload, are activated acutely by sudden overload, or develop gradually with prolonged contractions or repetitive activity. The diagnostic skill required depends on considerable innate palpation ability, authoritative training, and extensive clinical experience.
Therapy
Effective treatment methods include manual stretching by trigger-point pressure release, contract-relax, vapocoolant spray-and-stretch, and dry needling or injection of MTrPs.
Conclusions
The integrated hypothesis presents an explanation for the pathophysiology of MTrPs and begins with excessive release of acetylcholine from involved motor endplates. It depends on a new understanding of the abnormality of endplate noise. Biopsies demonstrate segmental shortening of groups of sarcomeres in individual muscle fibres and possibly waves of contracted sarcomeres to account for palpable taut bands.
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Simons, D.G., Mense, S. Diagnose und Therapie myofaszialer Triggerpunkte. Schmerz 17, 419–424 (2003). https://doi.org/10.1007/s00482-003-0253-7
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DOI: https://doi.org/10.1007/s00482-003-0253-7