Muscle spasms evaluation

Central Muscle Relaxants - There appeared during the year an excellent re-view oi the synthetic centrally acting skeletal muscle relaxants which covers the literature through most of 1966 ". As the authors, Donahoe and Kimura, point out, there continues to be a need for effective chemical compounds which relieve painful skeletal muscle spasms without producing muscular weakness or incapacitating sedative or hypnotic effects. Since most of the clinically useful compounds fall within a few structural classes there is a need for more basic studies involving molecular alteration for evaluation as central muscle relaxants. 

A complete physical must be performed and any possible organic causes ruled out. Muscle spasms, scoliosis, leg length discrepancies, arches of the feet, craniosacral motion, and somatic dysfunctions must be evaluated. Asymmetries of any postural mechanisms can be reflected at the TMJ. 

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The levator scapula muscle is frequently involved in neck and posterior shoulder pain. Spasm of this muscle often occurs due to overuse in persons using computers or typewriters. These individuals need to be evaluated for correct posture and ergonomic working conditions. Taking time to stretch and relax the cervical muscles helps prevent this common problem. Untreated, trigger points tend to form in this muscle leading to increased pain and disability. 

The physician then palpates deeper into the muscle tissue. The paraspinal muscles lie parallel to the spinal column. They are larger in the lumbar region than in other regions of the spine. The quadratus lumborum attaches to the twelfth rib, the spinal column, and the crest of the ilium. These muscles are frequently the source of low back pain and should be evaluated for hypertonicity, spasm, bogginess, and other tissue texture changes. 

The lirst rib is probably the rib most commonly involved in somatic dysfunction of all the ribs. It is affected by trauma, stress, and posture as well as by dysfunction ofthe C7-T1 complex. The patient may report "shoulder" pain, stiff neck, upper back or neck pain, and an inability to turn the head while driving. The first rib can impinge the neurovascular bundle as it passes between it and the clavicle through the costoclavicular space. The anterior and middle scalene muscles, which raise the first rib, may likewise compress the brachial plexus when they are in spasm and result in thoracic outlet syndrome symptoms. The patient s symptoms are then described as pain, numbness, or paresthesias ofthe arm or hand on the involved side. The physician needs to be aware that this may cause confusion should the patient demonstrate a herniated cervical disc on magnetic resonance imaging [MRO. The symptoms may be caused by the rib dysfunction rather than the herniated disc, so evaluation ofthe rib for normal motion and treatment of any dysfunction should be performed in these cases. Osteopathic manipulation may save the patient unnecessary surgery. 

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