Trigger point s (TrPs) examination in Abductor hallucis muscle
The Trigger Points (TrPs) are hyperirritable spots a\w a hypersensitive palpable tight nodule located in a taut band of fibers of Abductor hallucis muscle and that when touched or pressured, produce exquisite local tenderness and a jump response and will rarely elicit a local twitch response. The Trigger Points Area is typically painful to compression, causing characteristic referred pain and hypersensitivity, motor dysfunction and even autonomic phenomena.
For a correct diagnosis of Myofascial Pain Syndrome is basic the detection of a taut band, the presence of spot tenderness, the presence of referred pain and reproduction of the patient's symptomatic pain (Four criteria of Gerwin for diagnosis of Myofascial Pain Syndromes)
According to Podiatrist's Guide to Trigger Points & Myofascial Pain Syndrome for a correct diagnosis is basic to detect : Regional pain complaint; Taut band palpable in an accessible muscle; Exquisite spot of tenderness in the taut band; Pain complaint or altered sensation in the expected distribution of referred pain from the tender spot ; Some restricted range of motion, when measurable and in addition, in according with M.B. Yunus, at least one of the following minor criteria: Reproduction of clinical pain complaint, or altered sensation by pressure on the tender spot; Local twitch response by transverse snapping palpation of, or needle insertion into the taut band; Pain alleviation by stretching the involved muscle or injecting the tender spot in it.
The pattern of referred pain and hypersensitivity constitute the key for their identification because the trigger points of Abductor hallucis muscle produce pain locally (right where they are) as well as often referred pain to other areas
Using immune-capillary electrophoresis and capillary electro-chromatography Jay P. Shah and others have shown that biochemical milieu of selected inflammatory mediators, neuropeptides, cytokines and catecholamines like bradykinin, substance P, calcitonin gene-related peptide, tumor necrosis factor alpha, interleukin 1β (IL-1β), IL-6, IL-8, serotonin, and norepinephrine in subjects with active MTPs are different from subjects with latent or absent MTPs H See also Jay P. Shah MD, Jerome V. Danoff © 2008 American Congress of Rehabilitation Medicine
"Muscles of the foot are examined by flat palpation against underlying structures . The TrPs are identified primarily by the patient's jump response to exquisite spot tenderness in a taut band. These muscles rarely exhibit local twitch responses to snapping palpation Janet G. Travell and David G. Simons
Click for the three common locations of Trigger point (TrPs) in the Abductor hallucis muscle: they are identified by the patient's jump response to exquisite spot tenderness in a taut band of the muscle which is examined by pincer palpation along the medial edge of the sole of the foot. The three trigger points are located distal to , intermediate to and proximal to the base of the first metatarsal bone (see picture)