Anatomical Basis of the Myofascial Trigger Points of the Gluteus Maximus Muscle

Flavia Emi Akamatsu,Mauro Andrade,Tatiana Mina Yendo,Alfredo Luiz Jacomo,Flávio Hojaij,Ana Maria Itezerote,Wu Tu Hsing,Ciro Rhode

doi:10.1155/2017/4821968

Abstract

Myofascial pain syndrome is characterized by pain and limited range of motion in joints and caused by muscular contracture related to dysfunctional motor end plates and myofascial trigger points (MTrPs). We aimed to observe the anatomical correlation between the clinically described MTrPs and the entry point of the branches of the inferior gluteal nerve into the gluteus maximus muscle. We dissected twenty gluteus maximus muscles from 10 human adult cadavers (5 males and 5 females). We measured the muscles and compiled the distribution of the nerve branches into each of the quadrants of the muscle. Statistical analysis was performed by using Student's t-test and Kruskal-Wallis tests. Although no difference was observed either for muscle measurements or for distribution of nerve branching among the subjects, the topography of MTrPs matched the anatomical location of the entry points into the muscle. Thus, anatomical substract of the MTrPs may be useful for a better understanding of the physiopathology of these disorders and provide basis for their surgical and clinical treatment.

Highlights

Chronic pain is a major public health burden and its reported prevalence ranges widely between 2 and 45% [1].Musculoskeletal problems account for most cases of chronic pain and myofascial pain syndrome and its prevalence among all causes of this chronic musculoskeletal pain is estimated to be 13,7% to 47% [2,3,4,5,6,7].Yet, large population studies are scarce and difficult to be undertaken due to methodological complexity and many studies focus on specific disorders
These focal hypersensitivity areas are known as myofascial trigger points (MTrPs) [2, 8, 10, 11] and are associated with dysfunctional motor endplates [8, 10, 12,13,14]
Increased concentration of acetylcholine (ACh) in the synaptic cleft, changes in ACh receptor (AChR), and changes in acetylcholinesterase (AChE) activity are consistent with known mechanisms of endplate dysfunction and could explain the increase in endplate electrical activity that is seen in the active MTrPs [22]

Summary

Introduction

Chronic pain is a major public health burden and its reported prevalence ranges widely between 2 and 45% [1].Musculoskeletal problems account for most cases of chronic pain and myofascial pain syndrome and its prevalence among all causes of this chronic musculoskeletal pain is estimated to be 13,7% to 47% [2,3,4,5,6,7].Yet, large population studies are scarce and difficult to be undertaken due to methodological complexity and many studies focus on specific disorders. MPS is clinically expressed by referred pain [7], limited range of motion in joints, and a local twitch response triggered by mechanical stimulation of certain muscular and fascial regions [9]. These focal hypersensitivity areas are known as myofascial trigger points (MTrPs) [2, 8, 10, 11] and are associated with dysfunctional motor endplates [8, 10, 12,13,14].

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