Interrater reliability of palpation of myofascial trigger points in three shoulder muscles

Abstract

This observational study included both asymptomatic subjects (n=8) and patients with unilateral or bilateral shoulder pain (n=32). Patient diagnoses provided by the referring medical physicians included subacromial impingement, rotator cuff disease, tendonitis, tendinopathy, and chronic subdeltoid-subacromial bursitis. Three raters bilaterally palpated the infraspinatus, the anterior deltoid, and the biceps brachii muscles for clinical characteristics of a total of 12 myofascial trigger points (MTrPs) as described by Simons et al. The raters were blinded to whether the shoulder of the subject was painful. In this study, the most reliable features of trigger points were the referred pain sensation and the jump sign. Percentage of pair-wise agreement (PA) was >/= 70% (range 63-93%) in all but 3 instances for the referred pain sensation. For the jump sign, PA was >/= 70% (range 67-77%) in 21 instances. Finding a nodule in a taut band (PA = 45-90%) and eliciting a local twitch response (PA = 33-100%) were shown to be least reliable. The best agreement about the presence or absence of MTrPs was found for the infraspinatus muscle (PA = 69-80%). This study provides preliminary evidence that MTrP palpation is a reliable and, therefore, potentially useful diagnostic tool in the diagnosis of myofascial pain in patients with non-traumatic shoulder pain.

Keywords: Interrater Reliability; Myofascial Pain Syndrome; Myofascial Trigger Points; Palpation; Shoulder Pain.

Fig. 1

The localization of trigger points in the infraspinatus muscle, biceps brachii, and the anterior deltoid muscles. The numbers correspond with the sequence of palpation during the test.

Fig. 2

The localization of trigger points in the infraspinatus, biceps brachii and the anterior deltoid muscle and the referred pain patterns according to Simons et al. X = trigger point Solid gray shows the essential referred pain zone, nearly present in all patients, while the stippling represents the spillover zone, present in some but not all patients.

Fig. 3

Palpation technique for trigger point palpation of the infraspinatus muscle, anterior deltoid muscle, and the biceps brachii muscle, respectively.

Fig. 4

This box-n-whisker plot shows the graphical expression [i.e., median, lower and upper quartile, minimum and the maximum value] of the dataset from the pairs of raters. This graphic shows only small differences (not statistically or clinically relevant differences) between the three pairs of observers.