04/02/2021
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πππππ: Super Pulsed Laser for Scalenus Trigger Points Mimicking Cervical Radicular Symptoms.
πππππππππ: Scalenus Trigger Points is a set of muscles in the anterior cervical spine, the function of which is quite complex and, likewise, can create quite a complex clinical picture when they develop myofascial trigger points which become symptomatic. Because scalene myofascial pain syndrome mimics cervical radiculopathy, this condition often leads to mismanagement, which can, in turn, result in persistent pain and suffering. Because the clinical findings in scalene myofascial pain syndrome are pathognomonic, clinicians should be aware of ways to recognize this disorder and be able to differentiate it from other conditions that present with neck pain and radiculopathy.
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πππ: 58-year-old white female. Complaints of right-sided neck pain radiating into the right shoulder, parascapular region and left arm following the C6 dermatome to the thumb and index finger. Onset was two days after a rear end motor vehicle accident.
Patient was initially seen in the local ER. Released with meds and told to follow up with her general practitioner (GP) if she felt the need. GP was consulted and patient was referred to an orthopedist. Examination was unremarkable apart from soft tissue trauma to the cervical region. CT scan was unremarkable. Referral for physical therapy (PT) was made. An 8-week course of PT was prescribed with only temporary relief post PT session. Patient was release from PT and all care with residuals.
πππππππππππ: Patient self-referred to my office for evaluation and treatment after 8 months of symptoms. Initially I suspected she was suffering from a C6 injury on the right with radiating symptoms just from the presentation of her symptoms. None of my examination findings supported this working diagnosis. I began to look for other conditions that could mimic at C6 radicular pain pattern.
I found that trigger points in the scalene muscle are capable of mimicking C6 Radicular pain. With an otherwise normal examination, I examined the right and left scalene group. Sure enough, there was a string of trigger points in the anterior scalene on the right side.
ππππππππππππ: These trigger points were treated with 1,000 Hz using the general utility (GU) probe with a treatment time of 60 seconds followed by re-examination and additional time if indicated.
ππππππππ: Over trial course of 6 treatments with PBM for the trigger points she was enjoying marked improvements. The limb complaints were minimal and most of her discomfort was parascapular. The decision was to add exercises and continue with 6 additional sessions to resolution.
ππππππππππ: Super pulsed laser applied with the GU probe was an effective means to resolve patientβs trigger points. The distribution of complaints suggested that the pain generator was neurological involving C6. This was not be the case. The limb pain was an offshoot of referred pain from injury to her right anterior scalene muscle. These same techniques can be applied almost universally to trigger points to resolve not only the trigger points but any associated referred symptoms.
Dr. Chris
