A 35-year-old female comes to your office with a 1-year history of "aching and hurting all over". In addition, she complains of a chronic headache, difficulty sleeping, and generalized fatigue.
When questioned carefully, she describes "muscle areas tender to touch." Although the pain is "worse in the back," there is really is no place where it doesn't exist. She also describes headaches, generalized abdominal pains, and some constipation
On examination, the most striking finding is the presence of 13 discrete "trigger points".
These include the treapezius muscle, the sternomastoid, the masseter muscle, the levator scapulae, the muscles inserting into the area of the greater trochanter, the muscles inserting into the upper border of the petellae, and six areas on the back that together cover almost the entire back areas
7th Edition•ISBN: 9780323527361Julie S Snyder, Mariann M Harding 7th Edition•ISBN: 9780323087896 (1 more)Julie S Snyder, Linda Lilley, Shelly Collins 14th Edition•ISBN: 9780323266925Nancy Peckenpaugh 8th Edition•ISBN: 9781260470512Barbara T Nagle, Hannah Ariel, Henry Hitner, Michele B. Kaufman, Yael Peimani-Lalehzarzadeh