Advertisement

Quantification of Myofascial Taut Bands

Published:October 09, 2015DOI:https://doi.org/10.1016/j.apmr.2015.09.019

      Highlights

      • Magnetic resonance elastography is a magnetic resonance imaging technique that can image changes in tissue stiffness.
      • Myofascial taut bands can be imaged and quantified by magnetic resonance.
      • Taut band stiffness is about twice that (11.5 vs 5.8kPa) of adjacent muscle tissue.
      • Stiffness of muscle adjacent to a taut band is similar to that of uninvolved muscles.

      Abstract

      Objective

      To assess the correlation of clinician-identified myofascial taut bands with their presence and characteristics on magnetic resonance elastography (MRE) imaging.

      Design

      Cross-sectional study.

      Setting

      A magnetic resonance imaging (MRI) research laboratory.

      Participants

      A convenience sample of adults (N=65; 45 women, 20 men) identified by skilled musculoskeletal physicians as having upper trapezius myofascial pain–associated taut bands.

      Interventions

      Subjects had their taut bands outlined and were positioned within a 1.5T MRI machine. Shear waves were induced with a pneumatic transducer located over the belly of the involved muscle. Wave propagation was visualized with MRE images across a vibration cycle. Imaging data were assessed independently by 2 skilled MRE interpreters.

      Main Outcome Measures

      The primary outcome measure was the determination of the intra- and interrater reliabilities of MRE taut band identification and their correlation with clinician identification of band presence. Secondary outcomes consisted of the elucidation of the physical characteristics of taut bands and their surrounding muscle tissue.

      Results

      MRE intra- and interrater reliability was excellent, with kappa coefficients and 95% confidence intervals (CIs) of .86 (.68–1.00) and .93 (.79–1.00), respectively. Stiffness in MRE-identified taut bands was elevated at a mean ± SD of 11.5±2.4kPa and fell to 5.8±0.9kPa in surrounding muscle tissue (P<.001); muscular tone in trapezius muscles without a taut band was relatively uniform at 6.6±2.1kPa. Agreement between the physicians and the MRE raters, however, was relatively poor (63.1%; 95% CI, 50.2%–74.7%).

      Conclusions

      Our findings suggest that while clinicians may overestimate, and current MRE techniques may underestimate, the presence of taut bands, these bands do exist, can be assessed quantitatively, and do represent localized areas of increased muscle stiffness.

      Keywords

      List of abbreviations:

      CI (confidence interval), MRE (magnetic resonance elastography), MRI (magnetic resonance imaging), ROI (region of interest)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gerwin R.D.
        Classification, epidemiology, and natural history of myofascial pain syndrome.
        Curr Pain Headache Rep. 2001; 5: 412-420
        • Wolfe F.
        • Clauw D.J.
        • Fitzcharles M.A.
        • et al.
        Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.
        J Rheumatol. 2011; 38: 1113-1122
        • Wolfe F.
        • Clauw D.J.
        • Fitzcharles M.A.
        • et al.
        The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.
        Arthritis Care Res (Hoboken). 2010; 62: 600-610
        • Travell J.
        • Simons L.S.
        • Simons D.G.
        Travell and Simon's myofascial pain and dysfunction.
        in: 2nd ed. Upper half of body. Vol 1. Williams & Wilkins, Baltimore1999
        • Chou L.W.
        • Hsieh Y.L.
        • Kao M.J.
        • Hong C.Z.
        Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle.
        Arch Phys Med Rehabil. 2009; 90: 905-912
        • Ge H.Y.
        • Monterde S.
        • Graven-Nielsen T.
        • Arendt-Nielsen L.
        Latent myofascial trigger points are associated with an increased intramuscular electromyographic activity during synergistic muscle activation.
        J Pain. 2014; 15: 181-187
        • Quintner J.L.
        • Bove G.M.
        • Cohen M.L.
        A critical evaluation of the trigger point phenomenon.
        Rheumatology (Oxford). 2015; 54: 392-399
        • Awad E.
        Interstitial myofibrositis: hypothesis of the mechanism.
        Arch Phys Med Rehabil. 1973; 54: 449-453
        • Brendstrup P.
        • Jespersen K.
        • Asboe H.
        Morphological and chemical connective tissue changes in fibrositic muscles.
        Ann Rheum Dis. 1957; 16: 438-440
        • Byrt C.S.
        • Grof C.P.
        • Furbank R.T.
        C4 plants as biofuel feedstocks: optimising biomass production and feedstock quality from a lignocellulosic perspective.
        J Integr Plant Biol. 2011; 53: 120-135
        • Fischer A.A.
        Pressure threshold meter: its use for quantification of tender spots.
        Arch Phys Med Rehabil. 1986; 67: 836-838
        • Fischer A.A.
        Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity.
        Pain. 1987; 28: 411-414
        • Fischer A.A.
        Documentation of myofascial trigger points.
        Arch Phys Med Rehabil. 1988; 69: 286-291
        • Shah J.P.
        • Danoff J.V.
        • Desai M.J.
        • et al.
        Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points.
        Arch Phys Med Rehabil. 2008; 89: 16-23
        • Shah J.P.
        • Phillips T.M.
        • Danoff J.V.
        • Gerber L.H.
        An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle.
        J Appl Physiol (1985). 2005; 99: 1977-1984
        • Manduca A.
        • Oliphant T.E.
        • Dresner M.A.
        • et al.
        Magnetic resonance elastography: non-invasive mapping of tissue elasticity.
        Med Image Anal. 2001; 5: 237-254
        • Muthupillai R.
        • Rossman P.J.
        • Lomas D.J.
        • Greenleaf J.F.
        • Riederer S.J.
        • Ehman R.L.
        Magnetic resonance imaging of transverse acoustic strain waves.
        Magn Reson Med. 1995; 36: 266-274
        • Bensamoun S.F.
        • Ringleb S.I.
        • Littrell L.
        • et al.
        Determination of thigh muscle stiffness using magnetic resonance elastography.
        J Magn Reson Imaging. 2006; 23: 242-247
        • Debernard L.
        • Robert L.
        • Charleux F.
        • Bensamoun S.F.
        Characterization of muscle architecture in children and adults using magnetic resonance elastography and ultrasound techniques.
        J Biomech. 2011; 44: 397-401
        • Sack I.
        • Bernarding J.
        • Braun J.
        Analysis of wave patterns in MR elastography of skeletal muscle using coupled harmonic oscillator simulations.
        Magn Reson Imaging. 2002; 20: 95-104
        • Uffmann K.
        • Maderwald S.
        • Ajaj W.
        • et al.
        In vivo elasticity measurements of extremity skeletal muscle with MR elastography.
        NMR Biomed. 2004; 17: 181-190
        • Ballyns J.J.
        • Shah J.P.
        • Hammond J.
        • Gebreab T.
        • Gerber L.H.
        • Sikdar S.
        Objective sonographic measures for characterizing myofascial trigger points associated with cervical pain.
        J Ultrasound Med. 2011; 30: 1331-1340
        • Sikdar S.
        • Shah J.P.
        • Gebreab T.
        • et al.
        Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue.
        Arch Phys Med Rehabil. 2009; 90: 1829-1838
        • Bennett R.M.
        • Goldenberg D.L.
        Fibromyalgia, myofascial pain, tender points and trigger points: splitting or lumping?.
        Arthritis Res Ther. 2011; 13: 117
        • Chou L.W.
        • Kao M.J.
        • Lin J.G.
        Probable mechanisms of needling therapies for myofascial pain control.
        Evid Based Complement Alternat Med. 2012; 2012: 705327
        • Ge H.Y.
        • Fernandez-de-Las-Penas C.
        • Yue S.W.
        Myofascial trigger points: spontaneous electrical activity and its consequences for pain induction and propagation.
        Chin Med. 2011; 6: 13
        • Ge H.Y.
        • Wang Y.
        • Fernandez-de-las-Penas C.
        • Graven-Nielsen T.
        • Danneskiold-Samsoe B.
        • Arendt-Nielsen L.
        Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients.
        Arthritis Res Ther. 2011; 13: R48
        • Ge H.Y.
        • Arendt-Nielsen L.
        Latent myofascial trigger points.
        Curr Pain Headache Rep. 2011; 15: 386-392
        • Fischer A.A.
        • Muller K.
        • Scholtissek C.
        Specific inhibition of the synthesis of influenza virus late proteins and stimulation of early, M2, and NS2 protein synthesis by 3-deazaadenosine.
        Virology. 1990; 177: 523-531
        • Simons D.G.
        • Travell J.
        Myofascial origins of low back pain. 1. Principles of diagnosis and treatment.
        Postgrad Med. 1983; 73 (68-70): 66
        • Chen Q.
        • Basford J.R.
        • An K.N.
        Ability of magnetic resonance elastography to assess taut bands.
        Clin Biomech (Bristol, Avon). 2008; 23: 7
        • Chen Q.
        • Bensamoun S.F.
        • Basford J.R.
        • Thompson J.
        • An K.N.
        Identification and quantification of myofascial taut bands with magnetic resonance elastography.
        Arch Phys Med Rehabil. 2007; 88: 1658-1661
        • Manduca A.
        • Muthupillai R.
        • Rossman P.J.
        • Greenleaf J.F.
        • Ehman R.L.
        Image processing for magnetic resonance elastography.
        SPIE Med Imaging. 1996; 2710: 616-623
        • Reddi S.S.
        • Rudin S.F.
        • Keshaven H.R.
        An optimal multiple threshold scheme for imaging segmentation.
        IEEE Trans Syst Man Cybern. 1984; SMC-14: 661-665
        • Byrt T.
        • Bishop J.
        • Carlin J.B.
        Bias, prevalence and kappa.
        J Clin Epidemiol. 1993; 46: 423-429
        • Viera A.J.
        • Garrett J.M.
        Understanding interobserver agreement: the kappa statistic.
        Fam Med. 2005; 37: 360-363
        • Al-Shenqiti A.M.
        • Oldham J.A.
        Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis.
        Clin Rehabil. 2005; 19: 482-487
        • Njoo K.H.
        • Van der Does E.
        The occurrence and inter-rater reliability of myofascial trigger points in the quadratus lumborum and gluteus medius: a prospective study in non-specific low back pain patients and controls in general practice.
        Pain. 1994; 58: 317-323
        • Hsieh C.Y.
        • Hong C.Z.
        • Adams A.H.
        • et al.
        Interexaminer reliability of the palpation of trigger points in the trunk and lower limb muscles.
        Arch Phys Med Rehabil. 2000; 81: 258-264
        • Lew P.C.
        • Lewis J.
        • Story I.
        Inter-therapist reliability in locating latent myofascial trigger points using palpation.
        Man Ther. 1997; 2: 87-90
        • Riddle D.L.
        • Rothstein J.M.
        Intertester reliability of McKenzie's classifications of the syndrome types present in patients with low back pain.
        Spine (Phila Pa 1976). 1993; 18: 1333-1344
        • Bron C.
        • Franssen J.
        • Wensing M.
        • Oostendorp R.A.
        Interrater reliability of palpation of myofascial trigger points in three shoulder muscles.
        J Man Manip Ther. 2007; 15: 203-215
        • Lopez O.
        • Amrami K.K.
        • Manduca A.
        • Ehman R.L.
        Characterization of the dynamic shear properties of hyaline cartilage using high-frequency dynamic MR elastography.
        Magn Reson Med. 2008; 59: 356-364