Ultrasound imaging of embedded shrapnel facilitates diagnosis and management of myofascial pain syndrome

Exploring transvaginal sonographic characteristics of the levator ani muscle in women with postpartum pelvic floor myofascial pain

BACKGROUND

Pelvic floor myofascial pain is one of the pelvic floor dysfunction diseases disturbing women after delivery. There is a lack of objective standardization for the diagnosis of pelvic floor myofascial pain due to the various symptoms and the dependence on the palpating evaluation. Ultrasound imaging has the advantages of safety, simplicity, economy and high resolution, which makes it an ideal tool for the assistant diagnosis of pelvic floor myofascial pain and evaluation after treatment.

METHODS

This is a retrospective case-control study including women accepting evaluation of pelvic floor function at 6 weeks to 1 year postpartum. They were divided into pelvic floor myofascial pain group and normal control group. A BCL 10-5 biplane transducer was applied to observed their puborectalis. The length, minimum width, area, deficiency, deficiency length, deficiency width, deficiency area, rate of deficiency area, local thickening,angle between the tendinous arch of levator ani muscle and puborectalis of corresponding puborectalis in different groups were observed and measured.

RESULTS

A total of 220 postpartum women participated in the study, with 77 in the pelvic floor myofascial pain group and 143 in the normal control group. The Intraclass correlation coefficient value was over 0.750, and Kappa ranged from 0.600 to 0.800. puborectalis deficiency (adjusted odds ratio = 11.625, 95% confidence interval = 4.557-29.658) and focal thickening (adjusted odds ratio = 16.891, 95% confidence interval = 1.819-156.805) were significantly associated with higher odds of having postpartum pelvic floor myofascial pain. Grayscale or the angle between the arch tendineus levator ani and puborectalis measurements on the pain side tended to be smaller than on the non-pain side in patients with unilateral puborectalis or iliococcygeus pain (P < 0.05).

CONCLUSIONS

This study demonstrated that transvaginal ultrasound was a potentially efficient technique for evaluating postpartum pelvic floor myofascial pain due to its ability to assess various sonographic characteristics of the levator ani muscles.

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

Objective:

Myofascial trigger points (MTrPs) are pathognomonic of myofascial pain syndrome. The detection ability of MTrPs via ultrasonography is underreported and the characteristics of MTrPs are not sufficiently standardized. The objective was to summarize the characteristics and diagnostic abilities of ultrasonography for MTrP investigations.

Materials and Methods:

A multi-database, and bibliography hand-search was implemented. Studies of ≥10 patients, published after 1980, appraising ultrasonography as a diagnostic aid for myofascial pain syndrome were included. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used to evaluate the diagnostic accuracy of the included studies.

Results:

Six cross-sectional studies met the inclusion criteria. The back and trapezius muscles were the most studied locations. The diagnostic studies were of low-medium risk of bias. The studies reported a large range of diagnostic metrics (accuracy 58%–100%, sensitivity 33%–91%, specificity 75%–100%, positive predictive value 91%–100%, negative predictive value 47%–97%, positive likelihood ratio 3.6, and negative likelihood ratio 0.12–0.67).

Conclusion:

This review found low-medium risk of bias evidence in support of ultrasonography for MTrP investigations. The clinical studies identified in the scoping review used gray-scale ultrasound equipment systems with a 5 to 14 MHz transducer to diagnose MTrPs and the local twitch response, and MTrPs were visualized mostly as hypoechoic nodules.

Reliability of the Upper Trapezius Muscle and Fascia Thickness and Strain Ratio Measures by Ultrasonography and Sonoelastography in Participants With Myofascial Pain Syndrome

Objective

The purpose of this study was to assess the intra- and interexaminer reliability of the upper trapezius muscle and fascia thickness measured by ultrasonography imaging and strain ratio by sonoelastography in participants with myofascial pain syndrome.

Methods

Thirty-two upper trapezius muscles were assessed. Two examiners measured the upper trapezius thickness and strain ratio 3 times by ultrasonography and sonoelastography independently in the test session. The retest session was completed 6 to 8 days later.

Results

A total of 87.5% of participants had trigger points on the right side, and 22.5% had trigger points on the left side. For the test session, the average upper trapezius thickness, fascia thickness, and strain ratio measured by first and second examiners were 11.86 mm and 11.56 mm, 1.23 mm and 1.25 mm, and 0.94 and 0.99, respectively. For the retest session, the previously mentioned parameters obtained by first and second examiners were 11.76 mm and 11.39 mm, 1.27 mm and 1.29 mm, and 0.96 and 0.99, respectively. The intraclass correlation coefficients indicated good to excellent reliability for both within-intraexaminer (0.78-0.96) and between-intraexaminer (0.75-0.98) measurements. Also, the intraclass correlation coefficients and standard errors of measurement of interexaminer reliability ranged between 0.88 to 0.93 and 0.05 to 0.44 for both muscle and fascia thickness and 0.70 to 0.75 and 0.04 to 0.20 for strain ratio of upper trapezius, respectively.

Conclusion

Upper trapezius thickness measurements by ultrasonography and strain ratio by sonoelastography are reliable methods in participants with myofascial pain syndrome.

Ultrasonography for the assessment of the upper trapezius properties in healthy females: a reliability study

BACKGROUND

to date, an assessment of morphometric features, muscle stiffness and blood flow in the upper trapezius among healthy females at rest and contraction states has not been conducted. So, in the current research, the intra-rater reliability of ultrasonographic features of upper trapezius in healthy females was examined.

METHOD

in this study stiffness and thickness of the upper trapezius in rest and contraction states were measured by ultrasonography on 12 healthy female subjects (28.33±5.05 years old). Color Doppler imaging was used to assess muscle circulation in the rest state only. Every step and calculation of measurements was repeated 3 times with the same rater. Therefore, in total 36 measurements were done for each variable.

RESULTS

according to the analysis, the value of intra class correlation coefficient (ICC) for total variables showed an excellent level of reliability. Thickness at contraction had maximum reliability (ICC= 0.993) and Minimum Diastolic Velocity had the lowest reliability (ICC=0.771).

CONCLUSIONS

the results of current research demonstrated that real time ultrasonography is a reliable method for measurement of various parameters of upper trapezius, including morphometric features, its stiffness and blood supply in non-symptomatic females. These mentioned variables can likely be used for objective assessment and provide numerical reference value for clinical plans.

Targeting myofascial taut bands by ultrasound

Myofascial pain syndrome (MPS) is a frequent diagnosis in chronic pain and is characterized by tender, taut bands known as trigger points. The trigger points are painful areas in skeletal muscle that are associated with a palpable nodule within a taut band of muscle fibers. Despite the prevalence of myofascial pain syndrome, diagnosis is based on clinical criteria alone. A growing body of evidence that suggests that taut bands are readily visualized under ultrasound-guided exam, especially when results are correlated with elastography, multidimensional imaging, and physical exam findings such as local twitch response. The actual image characteristic in B mode appears to be controversial. Ultrasonography provides an objective modality to assist with diagnosis and treatment of trigger points in the future.

Botulinum toxin for the treatment of myofascial pain syndromes involving the neck and back: a review from a clinical perspective

Introduction. Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results. Material and Methods. We performed a content analysis of the clinical trials and systematic reviews of MPS. Results and Discussion. Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies.