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August 3, 1994
OBJECTIVES. (1) To confirm association of marked tenderness at the
coracoid tip, lateral pectoral and medial elbow sites, with
tenderness at the C6-7 level in the cervical spine. This had
been observed in subjects with prior neck pain, who lost
tenderness at C5-6 and standard upper body sites with neck
support during sleep, but remained symptomatic; (2) to
document apparent risk and prognostic factors; (3) to observe
the effects of a modified treatment strategy.
METHODS. A
protocol including possible risk and prognostic factors was
developed, and a case series assembled. Findings on entry
tested the hypothesized pattern of linked tender sites.
Subjects consenting to followup became a cohort in which
outcomes were studied.
RESULTS. In 151 subjects, there were
associations among the tenderness scores (mean r value of
0.59, p < 0.001) of points in the 6-7 group on the same side,
an intermediate level of association with contralateral but
homologous points (mean r value of 0.31), but weak
associations (mean r value 0.07) with contralateral and
different points. During followup, 47% obtained marked or
complete relief at their first followup visit, and a final
followup (median 18 months), 84% of those without previous
fibromyalgia (FM) achieved this satisfactory outcome, and 63%
of those with prior FM.
CONCLUSION. This experience supports the hypothesis that
mechanical factors determine patterns of symptoms and
tenderness in many subjects with regional and general pain
syndromes, and points to new strategies of diagnosis and
treatment which may be critical for success.
Smythe HA
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