Feasibility of Ultrasound-Guided Trigger Point Injection in Patients with Myofascial Pain Syndrome

Abstract

We compared the feasibility of ultrasound (US)-guided myofascial trigger point (MTrP) injection with that of a blind injection technique following the use of shear wave elastography (SWE) for the measurement of stiffness at the MTrPs in patients with trapezius myofascial pain syndrome (MPS). A total of 41 patients (n = 41) were randomized to either the trial group (n = 21, SWE combined with US-guided injection) or the control group (n = 20, SWE combined with blind injection). At baseline and four weeks, they were evaluated for the manual muscle test (MMT), the range of motion (ROM), pain visual analogue scale (VAS) scores, Shoulder Pain and Disability Index (SPADI) scores and Neck Disability Index (NDI) scores during the abduction, adduction, flexion, extension, external rotation and internal rotation of the shoulder joint. Differences in changes in pain VAS scores, NDI scores and SPADI scores at four weeks from baseline between the two groups reached statistical significance (p = 0.003, 0.012, and 0.018, respectively). US-guided MTrP injection is a more useful modality as compared with a blind injection in patients with MPS.

Is Shear-Wave Elastography a Clinical Severity Indicator of Myofascial Pain Syndrome? An Observational Study

“…Shear-wave elastography -SWE-is a non-invasive imaging technology, sensitive to tissue stiffness and develop to provide quantitative and objective data (e.g., Young modulus -kPa-and local shear wave speed -m/s-) [9] which has been used previously for assessing MTrP characteristics and showing controversial findings [10][11][12][13]. Whereas strain sonoelastography -SSE-was the first introduced elastography technique which measures physical tissue displacement parallel to the applied normal stress [14], SWE provides a more objective, reliable and valid method for quantifying muscle stiffness based on acoustically induced shear waves which travel perpendicularly to the compression waves with variate velocity depending on tissue stiffness [15].…”

Intramuscular Injections and Dry Needling within Masticatory Muscles in Management of Myofascial Pain. Systematic Review of Clinical Trials

“…The shear wave elastography allows for noninvasive assessment of soft tissue hardness; therefore, it can be a vital tool in localizing the MTPs, which are common target spots for needling therapies. Moreover, elastography is the right tool to evaluate the myofascial pain in correlation with muscles stiffness as well as the treatment results of injections therapies [ 68 , 69 ]. It is a promising tool for the assessment of masticatory muscles, especially the masseter as stated by Olchowy et al although there still is a significant need for more studies on larger groups to determine the accuracy of elastography to characterize masticatory muscles and their disorders [ 68 ].…”

Ultrasound‐guided interventions during pregnancy for lumbosacral pain unresponsive to conservative treatment: A retrospective review

“…Trigger points are basically hypoechoic structures on ultrasound, but may be imaged as fusiform or elliptic echogenic spots 26 . Trigger point injections have been shown to be more effective when performed under US guidance 27 . A review concluded that US guidance may be used for accurate localization of the trigger points as well as for the precise injection of the locally acting agents 28…”

“…26 Trigger point injections have been shown to be more effective when performed under US guidance. 27 A review concluded that US guidance may be used for accurate localization of the trigger points as well as for the precise injection of the locally acting agents. 28 Weight gain, hormonal alterations and postural changes associated with pregnancy may impair pelvic stability.…”