Ultrasonography in Diagnosis of Myofascial Pain Syndrome and Reliability of Novel Ultrasonic Indexes of Upper Trapezius Muscle

Abstract

SUMMARYBackground. Myofascial pain syndrome (MPS) is a common non-articular musculoskeletal disorder. It is characterized by local and referred pain due to the presence of myofascial trigger points (MTrPs). MTrPs most commonly involve the upper trapezius muscle and can be visualized using ultrasound imaging. This study was designed to determine the inter-rater reliability of some new ultrasonographic indices of the upper trapezius muscle and the sensitivity and specificity of 2D ultrasound imaging in the diagnosis of MPS.Materials and methods. This semi-experimental study enrolled 15 participants of both genders (mean age: 40.60 ± 5.74 years) with suspected symptoms of MPS. In the first step of the study, the sensitivity and specificity of ultrasonography for diagnosis of MPS was determined in a double blind manner. In the second step, some ultrasonographic measurements, such as muscle thickness, area of MTrPs in longitudinal view, echogenicity of MTrPs in longitudinal view, echogenicity of muscle with MTrPs in longitudinal and transverse views, and the pennation angle of the upper trapezius muscle were measured twice and their reliability was determined using the value of the mean of the two measurements.Results. The sensitivity and specificity of ultrasonographic diagnosis were 91% and 75%, respectively. The inter-rater reliability of upper trapezius muscle thickness, pennation angle, area of MTrPs, echogenicity of active MTrPs in longitudinal view, echogenicity of muscle with MTrPs in transverse view and echogenicity of muscle with MTrPs in longitudinal view were 0. 91, 0.96, 0.93, 0.83, 0.93, and 0.91, respectively. Conclusions. 1. Our findings indicated that ultrasonography is a useful method for the diagnosis of MPS owing to its high sensitivity. 2. Appropriate reliability of the quantitative ultrasonographic indices of interest, especially the area of MTrPs and their echogenicity, could be useful for long-term monitoring and designing interventional studies for better management of the syndrome.

Advances in the diagnosis and management of neck pain

“…78 Although ultrasound and other tests have been advocated to identify trigger points and myofascial neck pain, physical examination remains the reference standard. 79 One meta-analysis performed in people with chronic neck pain found that the point prevalence of active trigger points ranged from 14.8% in the right levator scapula to 38.5% in the right upper trapezius. 80 The treatment of myofascial pain should be multimodal and should include correcting underlying structural and postural imbalances, physical therapy (for example, massage and range of motion exercises), drugs, and psychotherapy (including cognitive behavioral therapy and biofeedback).…”

Diagnostic Applications of Ultrasonography in Myofascial Trigger Points: A Scoping Review and Critical Appraisal of Literature

“…The included studies (see Table 1) are cross-sectional clinical diagnostic research conducted in the United States, 60 Iran, 61 South Korea, 62 Egypt, 61 Malaysia, 49 and Australia. 63 One study was published in 1999, 63 and the remaining studies were published from 2011 to 2016.…”

“…MTrPs were defined as 0.05 to 0.5 cm 2 heterogeneous, 60,61 hypoechoic clusters 1 or single nodules. 1,60,61 Two exceptions were Lewis and Tehan, 63 who described MTrPs as 5 mm hyperechoic nodules; and Hafiza et al, 49 who described the MTrPs as the peak of a curved muscle structure. The twitch response was defined as a momentary contraction.…”

Piriformis syndrome with red flag signs

“…[1,7]. Taheri et al describe that the musculoskeletal ultrasonography has higher sensitivity in diagnosing hypoechoeic myofascial trigger points and appears to be useful in diagnosing piriformis myofascial pain syndrome, however its reliability should be tested in a longitudinal study with large number study participants [15]. So in terms of confirmed diagnostic test for PS we are yet to have the most appropriate one.…”