Laboratory Findings:

CBC, chem screen, sed rate, CPK, MRI, CT, EMG will be normal.  Test thyroid when the history and physical findings indicate that it may be a problem.  One study showed alterations in LD enzymes - LD1 and LD2 were decreased, LD3, 4,5 were increased, another study showed opposite alterations.  Thermograms of skin overlying the trigger point showed an increase in skin temperature 5-10 cm in diameter.  There is a small area of increased skin conductance, reduced skin resistance, over a trigger point area.

What to look for

1. A history of sudden onset following an acute overload stress, such as a whiplash or lifting injury, or a history of gradual onset with chronic overuse of the affected muscle.
2. Characteristic patterns of pain that are referred from myofascial trigger points specific to individual muscles.  Check your charts.
3. Weakness and restriction in the stretch range of the affected muscle.
4. A taut, palpable band in the affected muscle.
5. Exquisite, focal tenderness to digital pressure in the taught band of muscle fibers.
6. A local twitch response elicited through palpation of the tender spot.
7. Reproduction of the patient’s pain complaint or other symptoms by pressure on the trigger point.
8. Elimination of symptoms when the affected muscles are treated appropriately.  If the symptoms don’t get better - keep looking.
9. Exercise, physical therapy, or conditioning makes the pain worse when there are active trigger points in the muscle, but makes latent trigger points less prone to reactivation.

Rule Out: