Two years ago, I saw the first client diagnosed with myofascial pain syndrome. Her complaint was right side subacromial pain.  She had been to repeated rounds of physical therapy and, according to her, had let her doctors and physical therapists know that her right forearm was also an issue.  The PT had spent some time working on her right forearm, but it did not alleviate her pain.

My findings: I found that she had increased subacromial space on the right side.  This lead to a lengthening of middle deltoid which appeared to cause pain any time she did activity that used the muscle for any length of time (i.e. longer than a half a minute).

Additionally, her right radius was immobile and pulled anterior and toward pronation at the middle of the radius.  At the proximal end of her radius, the radius was shifted posterior, and the humeroradial joint had decreased space and lacked full extension.  Her bicep was shortened (possibly due to the limited extension of the radius and the decreased space in the humeroradial joint) and her tricep was fascially stuck to the posterior humerus.

But, this was only half the story her body was telling me.  She had decreased subacromial space on the left, leaving middle deltoid on the left shortened.  Her shoulder girdle was shifted to the left (meaning her sternum moved easier to the left, her right and left scapulas moved easier to the left, and her clavicles moved easier to the left).

The inferior fascial drag along the lateral aspect of the right shoulder continued through the humerus and to the the humeroradial joint.  The right humerus moved easiest into adduction, which, coupled with the fascial drag on the lateral aspect of the upper arm, lead to a fascial pull on the medial side of the upper arm and tension in the axilla.

So, which of these issues were the root of the shoulder pain that had been diagnosed as myofascial pain syndrome?  None.  It was the interaction of all of these dynamics, all of these fascial pulls and drags, all of the tension patterns and bony immobilizations that lead to pain in her right subacromial area.

Since seeing this client, I have seen multiple other clients diagnosed with myofascial pain syndrome for shoulder pain. Each has a similar issue, although for one of these clients the opposite side tension is in the posterior and lateral neck.

I imagine the diagnosis of myofascial pain syndrome could be given for any part of the body.  I wonder how often that diagnosis is given due to misunderstood structural patterns.