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Myofascial Pain Secondary to Duane Syndrome: A Case Study

Introduction: Myofascial pain in the trapezius, rhomboids, levator scapulae and sternocleidomastoid is often linked to cervical and thoracic disc degeneration and facet osteoarthritis as well as postural imbalances and muscle deconditioning. 
Case Report: We present the case of a 37-year-old female with Duane Syndrome who presented with chronic neck and mid-back pain. We tried a multimodal approach to myofascial pain management, including physical therapy, nortriptyline 10 mg to address potential central sensitization as well as neuropathic pain, and trigger point injections. Ultimately, the patient underwent ocular surgery, after which her myofascial pain improved. Our other treatment interventions became significantly more effective after the surgery. 
Conclusion: To our knowledge, this is the first case in the literature of extraocular muscle disorders being associated with myofascial pain. It is also the first case of myofascial pain successfully treated by corrective oculoplastic surgery. Extraocular disorders can lead to overuse or repetitive trauma to the trapezius, rhomboids, levator scapulae, sternocleidomastoid and other muscles of the neck and trunk as the patient uses compensatory motions to ease their visual difficulties. This overuse can then lead to myofascial pain and trigger point formation.