Content area
Full Text
Surg Radiol Anat (2011) 33:891896 DOI 10.1007/s00276-011-0876-9
ORIGINAL ARTICLE
Hyaluronan within fascia in the etiology of myofascial pain
Carla Stecco R. Stern A. Porzionato
V. Macchi S. Masiero A. Stecco
R. De Caro
Received: 8 August 2011 / Accepted: 12 September 2011 / Published online: 2 October 2011 Springer-Verlag 2011
Abstract The layers of loose connective tissue within deep fasciae were studied with particular emphasis on the histochemical distribution of hyaluronan (HA). Samples of deep fascia together with the underlying muscles were taken from neck, abdomen and thigh from three fresh nonembalmed cadavers. Samples were stained with hematoxylineosin, Azan-Mallory, Alcian blue and a biotinylated HA-binding protein specic for HA. An ultrasound study was also performed on 22 voluntary subjects to analyze the thickness of these deep fasciae and their sublayers. The deep fascia presented a layer of HA between fascia and the muscle and within the loose connective tissue that divided different brous sublayers of the deep fascia. A layer of broblast-like cells that stained prominently with Alcian blue stain was observed. It was postulated that these are cells specialized for the biosynthesis of the HA-rich matrix. These cells we have termed fasciacytes, and may represent a new class of cells not previously recognized. The ultrasound study highlighted a mean thickness of 1.88 mm of the fascia lata, 1.68 mm of the rectus sheath, and1.73 mm of the sternocleidomastoid fascia. The HA within
the deep fascia facilitates the free sliding of two adjacent brous fascial layers, thus promoting the normal function associated with the deep fascia. If the HA assumes a more packed conformation, or more generally, if the loose connective tissue inside the fascia alters its density, the behavior of the entire deep fascia and the underlying muscle would be compromised. This, we predict, may be the basis of the common phenomenon known as myofascial pain.
Keywords Hyaluronic acid Fascia Sliding system
Loose connective tissue Fasciacyte Myofascial pain
Introduction
The etiology of myofascial pain is not certain. Some suggest a central origin of it, others a peripheral one. There is evidence of central nervous system sensitization and of hyperalgesia and temporal summation of pain in a specic area. Another hypothesis would suggest a facilitated processing of pain messages in the central nervous system,...