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Novel Applications of Ultrasound Technology to Visualize and Characterize Myofascial Trigger Points and Surrounding Soft Tissue

      Abstract

      Sikdar S, Shah JP, Gebreab T, Yen R-H, Gilliams E, Danoff J, Gerber LH. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue.

      Objective

      To apply ultrasound (US) imaging techniques to better describe the characteristics of myofascial trigger points (MTrPs) and the immediately adjacent soft tissue.

      Design

      Four sites in each patient were labeled based on physical examination as active myofascial trigger points (A-MTrPs; spontaneously painful), latent myofascial trigger points (L-MTrPs; nonpainful), or normal myofascial tissue. US examination was performed on each subject by a team blinded to the physical findings. A 12∼5MHz US transducer was used. Vibration sonoelastography (VSE) was performed by color Doppler variance imaging while simultaneously inducing vibrations (∼92Hz) with a handheld massage vibrator. Each site was assigned a tissue imaging score as follows: 0, uniform echogenicity and stiffness; 1, focal hypoechoic region with stiff nodule; 2, multiple hypoechoic regions with stiff nodules. Blood flow in the neighborhood of MTrPs was assessed using Doppler imaging. Each site was assigned a blood flow waveform score as follows: 0, normal arterial flow in muscle; 1, elevated diastolic flow; 2, high-resistance flow waveform with retrograde diastolic flow.

      Setting

      Biomedical research center.

      Participants

      Subjects (N=9) meeting Travell and Simons' criteria for MTrPs in a taut band in the upper trapezius.

      Interventions

      Not applicable.

      Main Outcome Measures

      MTrPs were evaluated by (1) physical examination, (2) pressure algometry, and (3) three types of US imaging including gray-scale (2-dimensional [2D] US), VSE, and Doppler.

      Results

      MTrPs appeared as focal, hypoechoic regions on 2D US, indicating local changes in tissue echogenicity, and as focal regions of reduced vibration amplitude on VSE, indicating a localized, stiff nodule. MTrPs were elliptical, with a size of .16±.11cm2. There were no significant differences in size between A-MTrPs and L-MTrPs. Sites containing MTrPs were more likely to have a higher tissue imaging score compared with normal myofascial tissue (P<.002). Small arteries (or enlarged arterioles) near A-MTrPs showed retrograde flow in diastole, indicating a highly resistive vascular bed. A-MTrP sites were more likely to have a higher blood flow score compared with L-MTrPs (P<.021).

      Conclusions

      Preliminary findings show that, under the conditions of this investigation, US imaging techniques can be used to distinguish myofascial tissue containing MTrPs from normal myofascial tissue (lacking trigger points). US enables visualization and some characterization of MTrPs and adjacent soft tissue.

      Key Words

      List of Abbreviations:

      A-MTrP (active myofascial trigger point), L-MTrP (latent myofascial trigger point), MPS (myofascial pain syndrome), MRE (magnetic resonance elastography), MTrP (myofascial trigger point), Po2 (partial pressure of oxygen), PPT (pain pressure threshold), RI (resistive index), 3D (3-dimensional), 2D (2-dimensional), US (ultrasound), VSE (vibration sonoelastography)
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