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

Abstract

Since manual palpation is a subjective procedure for identifying and differentiate Myofascial Trigger Points -MTrPs-, the use of Shear Wave Elastography -SWE- as an objective alternative is increasing. This study aimed to analyze pain pressure thresholds -PPTs- and SWE differences between active MTrPs, latent MTrPs and control points located in the upper trapezius to analyze the association of SWE features with clinical severity indicators (e.g., pain extension area, PPTs, neck pain and neck disability). An observational study was conducted to calculate the correlation and to analyze the differences of sociodemographic, clinical and SWE features on 34 asymptomatic subjects with latent MTrPs and 19 patients with neck pain and active MTrPs. Significant PPT differences between active with latent MTrPs (p < 0.001) and control points (p < 0.001) were found, but no differences between latent MTrPs and control points (p > 0.05). No stiffness differences were found between active MTrPs with latent MTrPs or control points (p > 0.05). However, significant control point stiffness differences between-samples were found (p < 0.05). SWE showed no significant correlation with clinical severity indicators (p > 0.05). No stiffness differences between active and latent MTrPs were found. Neck pain patients showed increased control point stiffness compared with asymptomatic subjects. SWE showed no association with clinical severity indicators.

Changes in Circadian Variations in Blood Pressure, Pain Pressure Threshold and the Elasticity of Tissue after a Whole-Body Photobiomodulation Treatment in Patients with Fibromyalgia: A Tripled-Blinded Randomized Clinical Trial

“…A physiotherapist, with 10 years of experience and an expert in musculoskeletal imaging, used the Logiq S7 with 15 MHz linear probe (GE Healthcare, Milwaukee, WI, USA) to carry out measurements on the subjects following the orientation guidelines used for tender point recognitions [ 41 ]. Given that the longitudinal plane demonstrated both a higher intra- and inter-examiner reliability (ICC = 0.66–0.74) than the transversal one [ 42 ], the transducer was positioned longitudinally to the muscle fibers with the center of the probe over the tender and control point locations and approximately 2–5 mm of compression was applied to the tissue.…”

Identifying Demographic, Clinical, Muscular and Histological Factors Associated with Ultrasound Cervical Multifidus Measurement Errors in a Chronic Neck Pain Population

“…In addition, since there are multiple imaging modes based on US technologies, multiple parameters can be easily and objectively assessed. For instance, the Doppler mode is useful for assessing vascular flows (facilitating the identification of vascular structures or assisting with the interventions’ effects on these vessels) [ 5 ], the M-mode assists with analyzing thickness changes in real-time (especially useful during motor control exercises if patients need feedback to ensure a correct muscle activation) [ 6 ], shear-wave elastography allows an objective assessment of a tissue’s stiffness [ 7 ] and panoramic US allows the measurement of large structures not measurable with conventional B-mode images [ 8 ].…”

Influence of Examiners’ Experience and Region of Interest Location on Semiquantitative Elastography Validity and Reliability

“…Furthermore, one study conducted by Jafari et al [33] assessed MTrP stiffness by using elastography imaging to quantitatively distinguish MTrP from normal tissue and obtained significant differences between MTrPs and the normal part of the muscle. However, a recent study found no stiffness differences between active and latent MTrPs or control points with MTrPs [12]. The methodology assessed on this study could be applied to calculate the SR between an MTrP control point or two control points (since it showed a good validity and reliability), its correlation with pain pressure thresholds and SR changes after treatment.…”

“…Although previous studies have assessed utility aspects of semi-quantitative strain elastography to calculate SR, most studies tackled references and targets with significant stiffness differences [8,9,11,13]. However, recent research focusing on MTrPs demonstrated that the magnitudes of stiffness differences in real tissues are smaller than the ones analyzed in phantoms [12]. As previous reports demonstrated that the accuracy of strain elastography is directly proportional to the stiffness difference between two points, the main novelty of this study lies in the selection of a homogeneous material to calculate the reliability between examiners and the instrument validity considering the region of interest location and the experience of the examiners.…”

“…Although strain elastography has been widely assessed in phantoms under optimal conditions previously, these reports compared the stiffness difference between targets and backgrounds in big magnitudes ranging from 11-55 kPa [8][9][10][11]. However, a recent study assessing stiffness differences between active and latent myofascial trigger points (MTrP) with control points within the same muscle showed smaller differences than those assessed in vitro (ranging from 0.04-2.76 kPa) [12]. Therefore, further research assessing the accuracy of SR calculation in tissues with similar stiffness is needed.…”