Objective Sonographic Measures for Characterizing Myofascial Trigger Points Associated With Cervical Pain

Abstract

Objectives The purpose of this study was to determine whether the physical properties and vascular environment of active myofascial trigger points associated with acute spontaneous cervical pain, asymptomatic latent trigger points, and palpably normal muscle differ in terms of the trigger point area, pulsatility index, and resistivity index, as measured by sonoelastography and Doppler imaging. Methods Sonoelastography was performed with an external 92-Hz vibration in the upper trapezius muscles in patients with acute cervical pain and at least 1 palpable trigger point (n = 44). The area of reduced vibration amplitude was measured as an estimate of the size of the stiff myofascial trigger points. Patients also underwent triplex Doppler imaging of the same region to analyze blood flow waveforms and calculate the pulsatility index of blood flow in vessels at or near the trigger points. Results On sonoelastography, active sites (spontaneously painful with palpable myofascial trigger points) had larger trigger points (mean ± SD, 0.57 ± 0.20 cm2) compared to latent sites (palpable trigger points painful on palpation; 0.36 ± 0.16 cm2) and palpably normal sites (0.17 ± 0.22 cm2; P < .01). Analysis of receiver operating characteristic curves showed that area measurements could robustly distinguish between active, latent, and normal sites (areas under the curve, 0.9 for active versus latent, 0.8 for active versus normal, and 0.8 for latent versus normal, respectively). Doppler spectral waveform data showed that vessels near active sites had a significantly higher pulsatility index (median, 8.3) compared to normal sites (median, 3.0; P < .05). Conclusions The results presented in this study show that myofascial trigger points may be classified by area using sonoelastography. Furthermore, monitoring the trigger point area and pulsatility index may be useful in evaluating the natural history of myofascial pain syndrome.

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

“…In 1 study of the trapezius muscle, in which ultrasound (US) elastography and Doppler imaging were used, investigators were able to demonstrate that active trigger points (identified by manual palpation) were larger and showed greater resistance to blood flow compared with latent trigger points. 16 The visualization of these trigger points was inferred by examining the elastographic map of the trapezius muscle after applying external vibration. Magnetic resonance (MR) elastography has also been used to examine palpated taut bands and demonstrated that these structures are significantly stiffer relative to controls.…”

Pathophysiology of myofascial trigger points: a review of literature

“…Estimates from a study [12] conducted by Danes found that in 37% of men and 65% women, aged 30-60 years have MTP. In the United States (U.S.), it is believed that the MTP affects 23 million Americans and is therefore considered a common disorder / neuromuscular dysfunction of motor and sensory origin [10]. Other studies claim that this disorder is prevalent in 20% to 50% of the population of many countries [13].…”

“…As such, these spontaneously or under mechanical stimulation of the skeletal muscle (muscle, tendon, or fascia) in the presence or absence of a adjacent local or pain [7], [8], [9]. Its existence is related to degenerative, inflammatory, infectious, neoplastic, metabolic, macro or micro trauma of various structures processes [10], [11] having as injury mechanisms postures, over weight, and physical and emotional stress, causing the tensioning on specific muscle groups and / or associates. Affecting mainly the cervical, shoulder girdle, lumbar and temporomandibular joint of individuals in the ost active age groups between 31 and 50 years of age [1], [8].…”

“…The central MTP has a close relationship with the terminals dysfunctional buttons, and is near the center of the muscle fibers. The junction is a MTP in the musculotendinous junction and / or insertion of bone muscle enthesopathy identifying characteristic caused by the voltage produced by a taut band central MTP [10], [16], [17]. Research reports that a MPT can imaging be considered a preclinical MTP active, phase and states that it is unknown to the natural history of latent MTP, but says as the importance of knowing timely identify them in order to prevent progression to active also telling queos MTP can be divided into primary and secondary.…”

“…One study found, in 200 asymptomatic young adults, a prevalence of MTP in 54% of women and 45% men, stating that the most affected is the trapezius muscle in both men and women, however, reported common occurrence the lower back, gluteal muscles, and the lumbar region square [15]. Symptoms associated with MTP are algia (burning, aching, stabbing or weight), decreased muscle strength, restricted range of motion, location or surrounding areas muscle fatigue, muscle stiffness, soreness, proprioceptive disorders (distortion of the weight of objects, tinnitus, dizziness and changes in perception) and autonomic phenomena (pilomotora activity, sweating, localized vasoconstriction, lacrimation and rhinorrhea) [1], [10], [14]. The MTP can be divided, according to their degree of sensitivity in latent, active, satellite and central junction.…”