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Aktif miyofasiyal tetik noktaların ultrason elastografi ile tedavisi sonrası semptomların düzelmesinin monitörizasyonu

Year 2019, Volume: 44 Issue: 3, 923 - 931, 30.09.2019
https://doi.org/10.17826/cumj.469425

Abstract

Amaç: Ultrason elastografi (UE), dokuların mekanik özelliklerini belirlemek için son zamanlarda geliştirilen bir yöntemdir. Bu çalışmada trapeziusun üst liflerindeki aktif miyofasyal tetik noktaları (MTrP) olan hastaların tedavi öncesi ve sonrası monitorizasyonunda aksiyel-strain UE'nin yararlılığını değerlendirmeyi amaçladık.

Gereç ve Yöntem: Çalışmaya miyofasiyal ağrı sendromlu 49 hasta (66 MTrP) dahil edildi. Hastalar iki tedavi grubuna, grup 1 (germe egzersizleri ile tetiknokta enjeksiyonu) ve grup 2 (tetik noktaenjeksiyonu) olarak randomize edildi. Gruplar tedaviden önce, 2 ve 14 gün sonra UE ile, ayrıca dizabilite, ağrı ve basınç ağrı eşiği (PPT) açısından değerlendirildi.

Bulgular: Her iki grupta tüm klinik parametreler, başlangıçta, tedavi sonrası 2 ve 14 gün sonra gerinim oranı (Strain ratio –SR) değeri ile kuvvetle ilişkiliydi. Ayrıca Grup 1, tedaviden sonraki 14 gün içinde grup 2'den daha iyi skorlara sahip olsa da her iki grupta dizabilite, ağrı ve tedavi sonrası PPT skorları açısından anlamlı iyileşmeler tespit edildi.

Sonuç: Çalışmamızda üst trapezius liflerinde MTrPs için SR değerlerinin başlangıçta ve tedavi sonrası klinik parametrelerle korele olduğu gösterilmiştir. Bu sonuçlara göre, aktif MTrPs 'li hastalarda değerlendirme ve iyileşmeyi izlemek için noninvaziv ve yarı-kantitatif bir yöntem olan aksiyel strain UE yararlı bir yöntem olabilir.


References

  • REFERENCES1. Garra BS: Elastography: current status, future prospects, and making it work for you. Ultrasound Q 2011;27:177–186. 2. Drakonaki EE, Allen GM, Wilson, DJ. Ultrasound elastography for musculoskeletal applications. The British Journal of Radiology 2012;85:1435-1445.3. Shiina T, Nightingale KR, Palmeri ML, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol2015;41:1126-1147. doi: 10.1016/j.ultrasmedbio.2015.03.009.4. Park GY, Kwon DR. Application of real-time sonoelastography in musculoskeletal diseases related to physical medicine and rehabilitation. American Journal of Physical Medicine & Rehabilitation 2011;90:875-886.5. Sconfienza LM, Silvestri E, Cimmino MA. Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes. ClinExpRheumatol2010;28:373–378.6. Hatta T, Yamamoto N, Sano H et al. In vivo measurement of rotator cuff tendon strain with ultrasound elastography: an investigation using a porcine model. J Ultrasound Med 2014;33:1641-1646.7. Gotoh A, Ariji Y, Hasegawa T, et al. Sonographic elastography for assessing changes in masseter muscle elasticity after low-level static contraction. Oral Radiol2013;29:140-145.8. Lalitha P, Reddy MCh, Reddy KJ. Musculoskeletal applications of elastography: a pictorial essay of our initial experience. Korean J Radiol2011;12:365–375.9. BotarJid C, Vasilescu D, Damian L et al. Musculoskeletal sonoelastography. Pictorial essay. Med Ultrason2012;14:239–245.10. Gong X, Wang Y, Xu P. Application of real-time ultrasound elastography for differential diagnosis of breast tumors. J Ultrasound Med 2013;32:2171–2176.11. Niitsu M, Michizaki A, Endo A et al. Muscle hardness measurement by using ultrasound elastography: a feasibility study. ActaRadiol2011;52:99–105.12. Yanagisawa O, Niitsu M, Kurihara T et al. Evaluation of human muscle hardness after dynamic exercise with ultrasound real-time tissue elastography: a feasibility study. ClinRadiol2011;66:815–819.13. Drakonaki EE, Allen GM. Magnetic resonance imaging, ultrasound and real-time ultrasound elastography of the thigh muscles in congenital muscle dystrophy. Skeletal Radiol2010;39:391–396.14. Akamatsu FE, Ayres BR, Saleh SO et al. Trigger points: an anatomical substratum. Biomed Res Int. 2015:623287. doi: 10.1155/2015/623287. 15. Simons DG, Travell JG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Lippincott Williams & Wilkins, Baltimore, 2005. 16. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins, Baltimore and London, 1983.17. Simons DG, Travell JG. Travell& Simons’ Myofascial Pain and Dysfunction. The Trigger Point Manual. Upper Half of Body. 2nd edition. vol. 1. Williams & Wilkins, Baltimore, 1999. 18. Cummings M, Baldry P. Regional myofascial pain: diagnosis and management. Best Pract Res ClinRheumatol2007;21:367–387.19. Brandenburg JE, Eby SF, Song P, et al. Ultrasound elastography: the new frontier in direct measurement of muscle stiffness. Arch Phys Med Rehabil2014;95:2207–2219.20. Cosgrove D, Piscaglia F, Bamber J et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 2013;34:238–253.21. Esenyel M, Caglar N, Aldemir T. Treatment of myofascial pain. Am J Phys Med Rehabil2000;79:48–52.22. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil1994;73:256–263.23. Bennett R. Myofascial pain syndromes and their evaluation. Best Pract Res ClinRheumatol2007;21:427–445.24. Hanten WP, Olson SL, Butts NL et al. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger paints. Phys Ther2000;80:997–1003. 25. Reeves JL, Jaeger B, Graff-Radford SB. Reliability of the pressure algometer as a measure of myofascial trigger point sensitity. Pain 1986;24:313–321.26. Long SP, Kephart W. Diagnostic Criteria: Myofascial pain syndrome. In: Ashburn MA, Rice LJ, eds. The management of pain. Churchill Livingstone, Philadelphia, 1999:299–321.27. Müller CEE, Aranha MFM, Gavião MBD. Two-Dimensional Ultrasound and Ultrasound Elastography Imaging of Trigger Points in Women with Myofascial Pain Syndrome Treated by Acupuncture and Electroacupuncture: A Double-Blinded Randomized Controlled Pilot Study. Ultrason Imaging 2015;37:152–167.28. Fischer AA. Application of pressure algometry in manual medicine. Journal of Manual Medicine 1990;5:145–150.29. Takala EP. Pressure pain threshold on upper trapezius and levator scapulae muscles. Scandinavian Journal of Rehabilitation Medicine 1990;22:63–68.30. Jensen MP, Turbner JA, Romano JM et al. Comparative reliability and validity of chronic pain intensity measures. Pain 1999;83:157–162.31. Wheeler AH, Goolkasian P, Baird AC et al. Development of the neck pain and disability scale. Item analysis, face, and criterion-related validity. Spine 1999;24:1290–1294.32. Bicer A, Yazici A, Camdeviren H et al. Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. DisabilRehabil. 2004;26:959–962.33. Rosen NB. Physical medicine and rehabilitation approaches to the management of myofascial pain and fibromyalgia syndromes. BaillieresClinRheumatol1994;8:881–916.34. Kamanli A, Kaya A, Ardicoglu O et al. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. RheumatolInt2005;25:604–611.35. Simon DG, TravellJG .Travell& Simon’s Myofascial Pain and Dysfunction: the Trigger Point Manual. 2nd edn. Williams & Wilkins, Baltimore,1999. 36. Pedersen M, Fredberg U, Langberg H. Sonoelastography as a diagnostic tool in the assessment of musculoskeletal alterations: a systematic review. Ultraschall Med 2012;33:441–446.37. Drakonaki EE, Allen GM, Wilson DJ. Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clinical Radiology 2009;64:1196–1202.38. Correas JM, Drakonakis E, Isidori AM et al. Update on ultrasound elastography: miscellanea. Prostate, testicle, musculo-skeletal. Eur J Radiol2013;82:1904–1912.39. Ariji Y, Katsumata A, Hiraiwa Y et al. Use of sonographic elastography of the masseter muscles for optimizing massage pressure: a preliminary study. J Oral Rehabil2009;36:627–635.40. Ooi CC, Malliaras P, Schneider ME et al. "Soft, hard, or just right?" Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skeletal Radiol2014;43:1-12. 41. Turan A, Teber MA, Yakut ZI et al. Sonoelastographic assessment of the age-related changes of the Achilles tendon. Medical ultrasonography 2015;17:58.42. LexellJ, Downham D, Sjöström M. Distribution of different fibre types in human skeletal muscles: fibre type arrangement in m. vastus lateralis from three groups of healthy men between 15 and 83 years. Journal of the neurological sciences 1986;72:211–222.43. Detorakis ET, Drakonaki EE, Tsilimbaris MK et al. Real-time ultrasound elastographic imaging of ocular and periocular tissues: a feasibility study. Ophthalmic Surg Lasers Imaging 2010;41:135–141.44. Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology 2015;54:392-399.

Monitoring symptom improvements after the treatment of active myofascial trigger points with ultrasound elastography

Year 2019, Volume: 44 Issue: 3, 923 - 931, 30.09.2019
https://doi.org/10.17826/cumj.469425

Abstract

Purpose: Ultrasound elastography (UE) is a recently developed technique and is used to determine the mechanical properties of tissues. We aimed to assess the usefulness of axial-strain UE for pre and post treatment evaluation of patients with active myofascial triggerpoints (MTrPs) of the upper trapezius.

Materials and Methods: The study included 49 patients (66 MTrPs) with myofascial pain syndrome. Patients were randomized into two treatment groups, group 1 (trigger point injection with stretching exercises) and group 2 (trigger point injection). The groups were evaluated with UE before, 2 and 14 days post-treatment. Disability, pain, and pressure pain threshold (PPT) were also assessed. 

Results: All clinical parameters were strongly correlated with strain ratio (SR) value at baseline, 2 and 14 days post-treatment. Both groups demonstrated significant improvements with respect to Neck Pain and Disability Scale , VAS, and PPT scores post-treatment. However, group 1 had better scores than group 2 in 14 days post-treatment. 

Conclusion: Our study demonstrated that SR values for MTrPs in the upper trapezius correlated with clinical parameters at baseline and after treatment. According to these results, axial-strain UE, which is non-invasive and semiquantitative method may be usefull to evaluation and monitor improvement in patients with active MTrPs.


References

  • REFERENCES1. Garra BS: Elastography: current status, future prospects, and making it work for you. Ultrasound Q 2011;27:177–186. 2. Drakonaki EE, Allen GM, Wilson, DJ. Ultrasound elastography for musculoskeletal applications. The British Journal of Radiology 2012;85:1435-1445.3. Shiina T, Nightingale KR, Palmeri ML, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol2015;41:1126-1147. doi: 10.1016/j.ultrasmedbio.2015.03.009.4. Park GY, Kwon DR. Application of real-time sonoelastography in musculoskeletal diseases related to physical medicine and rehabilitation. American Journal of Physical Medicine & Rehabilitation 2011;90:875-886.5. Sconfienza LM, Silvestri E, Cimmino MA. Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes. ClinExpRheumatol2010;28:373–378.6. Hatta T, Yamamoto N, Sano H et al. In vivo measurement of rotator cuff tendon strain with ultrasound elastography: an investigation using a porcine model. J Ultrasound Med 2014;33:1641-1646.7. Gotoh A, Ariji Y, Hasegawa T, et al. Sonographic elastography for assessing changes in masseter muscle elasticity after low-level static contraction. Oral Radiol2013;29:140-145.8. Lalitha P, Reddy MCh, Reddy KJ. Musculoskeletal applications of elastography: a pictorial essay of our initial experience. Korean J Radiol2011;12:365–375.9. BotarJid C, Vasilescu D, Damian L et al. Musculoskeletal sonoelastography. Pictorial essay. Med Ultrason2012;14:239–245.10. Gong X, Wang Y, Xu P. Application of real-time ultrasound elastography for differential diagnosis of breast tumors. J Ultrasound Med 2013;32:2171–2176.11. Niitsu M, Michizaki A, Endo A et al. Muscle hardness measurement by using ultrasound elastography: a feasibility study. ActaRadiol2011;52:99–105.12. Yanagisawa O, Niitsu M, Kurihara T et al. Evaluation of human muscle hardness after dynamic exercise with ultrasound real-time tissue elastography: a feasibility study. ClinRadiol2011;66:815–819.13. Drakonaki EE, Allen GM. Magnetic resonance imaging, ultrasound and real-time ultrasound elastography of the thigh muscles in congenital muscle dystrophy. Skeletal Radiol2010;39:391–396.14. Akamatsu FE, Ayres BR, Saleh SO et al. Trigger points: an anatomical substratum. Biomed Res Int. 2015:623287. doi: 10.1155/2015/623287. 15. Simons DG, Travell JG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Lippincott Williams & Wilkins, Baltimore, 2005. 16. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins, Baltimore and London, 1983.17. Simons DG, Travell JG. Travell& Simons’ Myofascial Pain and Dysfunction. The Trigger Point Manual. Upper Half of Body. 2nd edition. vol. 1. Williams & Wilkins, Baltimore, 1999. 18. Cummings M, Baldry P. Regional myofascial pain: diagnosis and management. Best Pract Res ClinRheumatol2007;21:367–387.19. Brandenburg JE, Eby SF, Song P, et al. Ultrasound elastography: the new frontier in direct measurement of muscle stiffness. Arch Phys Med Rehabil2014;95:2207–2219.20. Cosgrove D, Piscaglia F, Bamber J et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med 2013;34:238–253.21. Esenyel M, Caglar N, Aldemir T. Treatment of myofascial pain. Am J Phys Med Rehabil2000;79:48–52.22. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil1994;73:256–263.23. Bennett R. Myofascial pain syndromes and their evaluation. Best Pract Res ClinRheumatol2007;21:427–445.24. Hanten WP, Olson SL, Butts NL et al. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger paints. Phys Ther2000;80:997–1003. 25. Reeves JL, Jaeger B, Graff-Radford SB. Reliability of the pressure algometer as a measure of myofascial trigger point sensitity. Pain 1986;24:313–321.26. Long SP, Kephart W. Diagnostic Criteria: Myofascial pain syndrome. In: Ashburn MA, Rice LJ, eds. The management of pain. Churchill Livingstone, Philadelphia, 1999:299–321.27. Müller CEE, Aranha MFM, Gavião MBD. Two-Dimensional Ultrasound and Ultrasound Elastography Imaging of Trigger Points in Women with Myofascial Pain Syndrome Treated by Acupuncture and Electroacupuncture: A Double-Blinded Randomized Controlled Pilot Study. Ultrason Imaging 2015;37:152–167.28. Fischer AA. Application of pressure algometry in manual medicine. Journal of Manual Medicine 1990;5:145–150.29. Takala EP. Pressure pain threshold on upper trapezius and levator scapulae muscles. Scandinavian Journal of Rehabilitation Medicine 1990;22:63–68.30. Jensen MP, Turbner JA, Romano JM et al. Comparative reliability and validity of chronic pain intensity measures. Pain 1999;83:157–162.31. Wheeler AH, Goolkasian P, Baird AC et al. Development of the neck pain and disability scale. Item analysis, face, and criterion-related validity. Spine 1999;24:1290–1294.32. Bicer A, Yazici A, Camdeviren H et al. Assessment of pain and disability in patients with chronic neck pain: reliability and construct validity of the Turkish version of the neck pain and disability scale. DisabilRehabil. 2004;26:959–962.33. Rosen NB. Physical medicine and rehabilitation approaches to the management of myofascial pain and fibromyalgia syndromes. BaillieresClinRheumatol1994;8:881–916.34. Kamanli A, Kaya A, Ardicoglu O et al. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. RheumatolInt2005;25:604–611.35. Simon DG, TravellJG .Travell& Simon’s Myofascial Pain and Dysfunction: the Trigger Point Manual. 2nd edn. Williams & Wilkins, Baltimore,1999. 36. Pedersen M, Fredberg U, Langberg H. Sonoelastography as a diagnostic tool in the assessment of musculoskeletal alterations: a systematic review. Ultraschall Med 2012;33:441–446.37. Drakonaki EE, Allen GM, Wilson DJ. Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clinical Radiology 2009;64:1196–1202.38. Correas JM, Drakonakis E, Isidori AM et al. Update on ultrasound elastography: miscellanea. Prostate, testicle, musculo-skeletal. Eur J Radiol2013;82:1904–1912.39. Ariji Y, Katsumata A, Hiraiwa Y et al. Use of sonographic elastography of the masseter muscles for optimizing massage pressure: a preliminary study. J Oral Rehabil2009;36:627–635.40. Ooi CC, Malliaras P, Schneider ME et al. "Soft, hard, or just right?" Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skeletal Radiol2014;43:1-12. 41. Turan A, Teber MA, Yakut ZI et al. Sonoelastographic assessment of the age-related changes of the Achilles tendon. Medical ultrasonography 2015;17:58.42. LexellJ, Downham D, Sjöström M. Distribution of different fibre types in human skeletal muscles: fibre type arrangement in m. vastus lateralis from three groups of healthy men between 15 and 83 years. Journal of the neurological sciences 1986;72:211–222.43. Detorakis ET, Drakonaki EE, Tsilimbaris MK et al. Real-time ultrasound elastographic imaging of ocular and periocular tissues: a feasibility study. Ophthalmic Surg Lasers Imaging 2010;41:135–141.44. Quintner JL, Bove GM, Cohen ML. A critical evaluation of the trigger point phenomenon. Rheumatology 2015;54:392-399.
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Details

Primary Language English
Subjects Health Care Administration
Journal Section Research
Authors

Emine Eda Kurt 0000-0003-1237-8580

Yeliz Dadalı 0000-0002-5034-2055

Fatmanur Aybala Koçak 0000-0002-2224-3324

Hatice Rana Erdem This is me 0000-0001-8275-7645

Figen Tuncay This is me 0000-0002-0886-2006

Turgut Tursem Tokmak 0000-0002-1952-9911

Publication Date September 30, 2019
Acceptance Date February 8, 2019
Published in Issue Year 2019 Volume: 44 Issue: 3

Cite

MLA Kurt, Emine Eda et al. “Monitoring Symptom Improvements After the Treatment of Active Myofascial Trigger Points With Ultrasound Elastography”. Cukurova Medical Journal, vol. 44, no. 3, 2019, pp. 923-31, doi:10.17826/cumj.469425.