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Abstract
Objectives: To show that myofascial pain from muscular trigger points [TrPs] contributes significantly to post total knee arthroplasty pain and is amenable to treatment with a combination of manual physical therapy and TrP injections.
Methods: Ten patients with persistent knee pain after total knee arthroplasty were treated after orthopedic surgical examination ruled out knee instability and/or mechanical dysfunction of the arthroplasty. All ten patients had total knee arthroplasty for treatment of severe chronic degenerative joint disease which was documented by preoperative x-ray finding of bone on bone. All patients included had completed a physical therapy program ordered by the orthopedic surgeon and were released as maximally medically improved. The program consisted of passive and active range of motion exercises, strengthening and stabilization. These ten patients had persistent post total knee arthroplasty pain because of a myofascial pain syndrome. Subsequently, patients underwent an average of 12 manual physical therapy sessions coupled with an average of five TrP injection sessions. There was an average of 22 TrP injections performed per patient over the course of treatment. Pain levels were evaluated by use of numeric pain scale with 0 representing no pain and 10 being worst pain.
Results: These patients exhibited a post-discharge decrease in pain level of 87.5% on average, and on eight month follow-up, decrease in pain level of 75%. There was an average increase of 16 degrees in flexion and 6 degrees in extension on range of motion examination.
Conclusion: The authors conclude myofascial pain contributes significantly to the incidence of post total knee arthroplasty pain when orthopedic causes of component dysfunction have been ruled out. These myofascial pain syndromes, caused by muscular TrPs, are amenable to treatment combination of manual physical therapy and TrP injections.