Open Access Highly Accessed Research article

High prevalence of shoulder girdle muscles with myofascial trigger points in patients with shoulder pain

Carel Bron12*, Jan Dommerholt3, Boudewijn Stegenga4, Michel Wensing1 and Rob AB Oostendorp1

Author Affiliations

1 Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EX Nijmegen, The Netherlands

2 Practice for Physical Therapy for Neck, Shoulder and Upper Extremity Disorders, Groningen, Paulus Potterstraat 46, 9718 TK Groningen, The Netherlands

3 Bethesda Physiocare Inc., 7830 Old Georgetown Road, Suite C-15, Bethesda, MD 20814-2440, USA

4 Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

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BMC Musculoskeletal Disorders 2011, 12:139  doi:10.1186/1471-2474-12-139

Published: 28 June 2011



Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain.


An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72) for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ) was used to test for association between variables.


MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active MTrPs) and 4 (latent MTrPs). Active MTrPs were most prevalent in the infraspinatus (77%) and the upper trapezius muscles (58%), whereas latent MTrPs were most prevalent in the teres major (49%) and anterior deltoid muscles (38%). The number of muscles with active MTrPs was only moderately correlated with the DASH score.


The prevalence of muscles containing active and latent MTrPs in a sample of patients with chronic non-traumatic shoulder pain was high.

myofascial; pain; trigger points; prevalence; shoulder