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Pain and Spine Medicine

Complex Myofascial Pain Syndrome with Atypical Sensory Symptoms: A Case Report on Chronic Pain and Functional Restoration

Saturday, October 25, 2025
8:00 AM - 9:15 PM MT
Location: Kiosk 4

    Poster Presenter(s)

  • Kai Sheng Khor, MD

    Postdoctoral Research Fellow
    Johns Hopkins University PM&R Program
    Baltimore, Maryland

    • Co-Author(s)

  • DH

    Di Huang, MD

    Student
    Johns Hopkins Bloomberg school of Public Health
    Baltimore, Maryland

  • Jonny Huang, DPT

    Physical Therapist
    Johns Hopkins University PM&R Program
    Baltimore, Maryland

  • PR

    Preeti Raghavan, MD

    Associate Professor
    Johns Hopkins University School of Medicine
    Baltimore, Maryland

Disclosure(s):
Kai Sheng Khor, MD: No financial relationships to disclose
Jonny Huang, DPT: No financial relationships to disclose
Case Diagnosis: Complex Myofascial Pain Syndrome

Case Description or Program Description: A 46-year-old male presented with chronic neck and right arm pain with stiffness following a sudden right trapezius muscle strain with pain radiation and numbness to the little finger in 2021. Shortly afterwards he began to experience migraines, photosensitivity, and phonophobia. Despite undergoing cubital tunnel release, thoracic outlet decompression, and physical therapy, he reported minimal improvement and ultimately becoming unable to work by late 2022. Before his disability, the patient worked as a systems engineer and was physically active, performing approximately 300 pull-ups per day, three times a week. On physical examination in January 2023, the fingers and dorsum of the right hand and wrist showed noticeable swelling and skin discoloration. The upper trapezius was swollen and light touch to the right upper limb elicited hyperesthesia without allodynia. Active and passive movements of the proximal interphalangeal, metacarpophalangeal, and wrist joints were restricted, and abduction and flexion of the shoulder was limited to 90 degrees passively and actively. The muscles of the chest, upper back and upper limbs were stiff, tender and cord-like to palpation.

Setting: Tertiary Care Hospital

Assessment/Results: After one year of treatment, the patient reported significant pain reduction, near-normal range of motion, and resolution of migraines and photophobia. By mid-2024, his migraines had completely resolved, and he successfully returned to work.

Discussion (relevance): Overuse injury due to excessive pull-ups, likely caused trapezius muscle injury and multiple areas of myofascial densification resulting in myofascial pain syndrome and blood flow restriction, which resulted in swollen hands and skin discoloration. The patient was referred for hyaluronidase injections followed by fascial manipulation therapy to relieve the myofascial densifications.

Conclusions: This case underscores the debilitating effects of severe complex myofascial pain and stiffness and potential treatment with hyaluronidase injections and fascial manipulation.