Aspectos clínicos e funcionais da síndrome dolorosa miofascial em indivíduos com dor no ombro
The overall purpose of this doctorate thesis were to present information on the clinical aspects that involve the presence of myofascial trigger points (MTP) in shoulder and neck muscles, to verify the relationship between MTP and the clinical variables of pain, psychological aspects, mobility an...
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| Médium: | doctoralThesis |
| Jazyk: | pt_BR |
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Universidade Federal do Rio Grande do Norte
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| On-line přístup: | https://repositorio.ufrn.br/handle/123456789/32504 |
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| Shrnutí: | The overall purpose of this doctorate thesis were to present information on the clinical
aspects that involve the presence of myofascial trigger points (MTP) in shoulder and neck
muscles, to verify the relationship between MTP and the clinical variables of pain,
psychological aspects, mobility and strength and the effects of a physical therapy
approach on these aspects in individuals with non-traumatic shoulder pain. To this end,
three studies were carried out: Study 1 - Myofascial pain and trigger points in the shoulder
and neck region: from concept to physical therapy management; Study 2 - Relationship
and predictive capacity between active myofascial trigger points and physical, clinical
and psychological characteristics in individuals with shoulder pain; Study 3 - Immediate
effects of ischemic compression on myofacial trigger points on pain, mobility and
strength in individuals with subacromial impact syndrome: a single arm study. The study
1 is a literature review on MTPs in the shoulder and neck region that addresses definitions,
assessment reliability, sensitization phenomena, differential diagnosis, the relationship of
MTP with clinical variables and therapeutic management. Study 2 is a cross-sectional and
observational study. A total of 58 individuals (36 men and 22 women, aged between 31
± 10.91 years and BMI of 25.01 ± 3.42 kg/m²) participated in the study. All individuals
were assessed for physical and demographic characteristics, depression symptoms, pain
and shoulder function, presence of MTPs, ROM and pain during ROM and force. Pointbiserial (rpb) and Spearman (rs) correlation tests and multiple linear regression were used
to assess the relationship between the presence and quantity of MTPs and the study
variables, adopting a significance value of p<0.05. The presence and quantity of MTPs
generally correlated between weak to moderate with depression symptoms, pain during
sagittal flexion ROM and internal and external rotation, pain during sagittal lifting force,
self-reported shoulder function and external rotation force. The presence of MTPs in the
infraspinatus has been shown to influence depression symptoms; MTPs in the upper and
lower trapezius influenced pain during the internal rotation ROM; MTPs in the upper
trapezius influenced pain during internal rotation force; and MTPs in the supraspinatus
influenced pain during external rotation ROM. There is a weak to moderate correlation
between the presence and quantity of active MTPs and depression symptoms, pain during
shoulder ROM and force, ROM, force, and self-reported function. Study 3 is a single-arm
study. A total of 15 individuals (6 women and 9 men, 34.4 ± 10.43 years and 24.20 ± 2.18
kg/m2) with clinical symptoms of unilateral SIS. All individuals were assessed for the
amount of MTPs in the shoulder muscles; pressure pain threshold (PPT) in shoulder
muscles; range of motion of the shoulder; isometric strength of shoulder muscles; and
pain in performing ROM and isometric strength contraction. The evaluations took place
48 hours before the ICT, immediately before, and after the ICT. There was a reduction in
the total amount of MTPs and an increase in the PPT in the middle deltoid muscle in the
comparisons between pre and post treatment, while there was no difference in ROMs and
strength measures; however, the pain was less during the sagittal elevation ROM and
internal rotation, and during the performance of strength in arm elevation and external
rotation. There was generally no difference in the variables assessed between baseline
and pre-treatment. The ICT immediately reduced the amount of MTPs and pain during
mobility and strength, but did not change the PPT, ROM or strength variables. The present
study will support clinical practice in the management of shoulder and neck myofascial
pain in the presence of MTPs. |
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