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Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study

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Abstract

Our aim was to describe the differences in the presence of trigger points (TrPs) in the shoulder muscles and to investigate the presence of mechanical hypersensitivity in patients with unilateral shoulder impingement and healthy controls. Twelve patients with strictly unilateral shoulder impingement and 10 matched controls were recruited. TrPs in the levator scapula, supraspinatus, infraspinatus, subscapularis, pectoralis major, and biceps brachii muscles were explored. TrPs were considered active if the local and referred pain reproduced the pain symptoms and the patient recognized the pain as a familiar pain. Pressure pain thresholds (PPT) were assessed over the levator scapulae, supraspinatus, infraspinatus, pectoralis major, biceps brachii, and tibialis anterior muscles. Both explorations were randomly done by an assessor blinded to the subjects’ condition. Patients with shoulder impingement have a greater number of active (mean ± SD: 2.5 ± 1; P < 0.001) and latent (mean ± SD: 2 ± 1; P = 0.003) TrPs when compared to controls (only latent TrPs, mean ± SD: 1 ± 1). Active TrPs in the supraspinatus (67%), infraspinatus (42%), and subscapularis (42%) muscles were the most prevalent in the patient group. Patients showed a significant lower PPT in all muscles when compared to controls (P < 0.001). Within the patient group a significant positive correlation between the number of TrPs and pain intensity (r s = 0.578; P = 0.045) was found. Active TrPs in some muscles were associated to greater pain intensity and lower PPTs when compared to those with latent TrPs in the same muscles (P < 0.05). Significant negative correlations between pain intensity and PPT levels were found. Patients with shoulder impingement showed widespread pressure hypersensitivity and active TrPs in the shoulder muscles, which reproduce their clinical pain symptoms. Our results suggest both peripheral and central sensitisation mechanisms in patients with shoulder impingement syndrome.

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Acknowledgments

The study was funded by a research project grant from the High Altitude Sports Centre Sierra Nevada (Spanish High Council for Sports).

Conflict of interest statement

None declared by the authors.

Funding

No research funds were received by authors for this study.

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Authors and Affiliations

  1. Department of Physical Therapy, Universidad Granada, Granada, Spain

    Amparo Hidalgo-Lozano & Manuel Arroyo-Morales

  2. Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain

    César Fernández-de-las-Peñas

  3. Esthesiology Laboratory of Universidad Rey Juan Carlos, Alcorcón, Spain

    César Fernández-de-las-Peñas

  4. Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

    César Fernández-de-las-Peñas, Hong-You Ge & Lars Arendt-Nielsen

  5. Department of Health Sciences II, Universidad Rey Juan Carlos, Alcorcón, Spain

    Cristina Alonso-Blanco

  6. Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922, Alcorcón, Madrid, Spain

    César Fernández-de-las-Peñas

Authors
  1. Amparo Hidalgo-Lozano
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  2. César Fernández-de-las-Peñas
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  3. Cristina Alonso-Blanco
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  4. Hong-You Ge
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  5. Lars Arendt-Nielsen
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  6. Manuel Arroyo-Morales
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Correspondence to César Fernández-de-las-Peñas.

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Hidalgo-Lozano, A., Fernández-de-las-Peñas, C., Alonso-Blanco, C. et al. Muscle trigger points and pressure pain hyperalgesia in the shoulder muscles in patients with unilateral shoulder impingement: a blinded, controlled study. Exp Brain Res 202, 915–925 (2010). https://doi.org/10.1007/s00221-010-2196-4

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  • DOI: https://doi.org/10.1007/s00221-010-2196-4

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