Upper quarter myofascial pain syndrome in Singapore: Characteristics and treatment

Objectives: To study regional muscle distribution, pain intensity, and treatment outcome in upper quarter myofascial pain syndrome [UQMPS]. Methods: Patients with chronic UQMPS were referred to an occupational therapist of a multidisciplinary pain clinic over a two-year period. Hand dominance, regional muscle groups affected, pre- and posttreatment pain intensity by visual analog scale [VAS] were documented. Active myofascial trigger points were identified systematically and pain interventions included ischemic compression techniques, passive stretching, and physical modalities. Results: Altogether, there were 32 patients [25 females, seven males] with a mean age of 42.5 +/- 12.1 years. Mean pain duration was 3.21 +/- 2.5 years and bilaterality of symptoms was present in 65.5% of patients. The mean number of muscle groups affected per patient was 5.8 +/- 3.3. The nondominant upper limb was affected in 25%. Ninety-four percent [30] and 63% [20] had active trigger points located in the trapezius and scalenes, respectively. Other affected muscles included the rhomboids [59.4%], spinatii [53.1%], and sternocleidomastoids [18.8%]. Mean pretreatment VAS scores were 7.91 +/- 1.2. The median treatment period was five weeks, with twice-weekly treatment sessions and response rates of 100%. Posttreatment VAS scores were significantly reduced to 3.8 +/- 1.5 [P < 0.001]. Conclusions: Upper quarter myofacial pain syndrome may result in chronic, severe pain frequently involving the trapezius. physical therapeutic interventions can result in significant pain relief.