| 제목 |
Diagnostic Usefulness of elastography in myofascial pain syndrome |
| 소속 |
Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine1 |
| 저자 |
Sang Moon Yun1*, Sang Jun Kim1† |
Introduction
Myofascial pain syndrome (MPS) is defined as pain that originates from myofascial trigger points in skeletal muscle. The appropriate evaluation of myofascial pain syndrome is an important part of chronic pain management. The purpose of this study is to evaluate whether elastic ultrasound has diagnostic value in myofascial pain syndrome.
Materials and Methods
All patients were diagnosed as having unilateral MPS by clinical findings including focal tenderness at upper trapezius. To evaluate the symptom of pain around the trigger point, McGill Pain Questionnaire was used.
The ultrasound examination was performed using the RS85 (Samsung Medison Corporation, Korea, V1.05) with linear probe. All patients had examination of the bilateral upper trapezius muscles in sitting position using B-mode images and shear wave elastography to evaluate muscle stiffness and muscle thickness at the sites of the most tender point in longitudinal and transverse directions. The data obtained was analyzed using the mean value of Young's module (Emean) and standard deviation (SD).
Results
Total 15 patients (6 males and 9 females) were included in this study. There was no significant difference in thickness of the trapezius between symptomatic and intact side(p value 0.47). The elasticity of trapezius muscles demonstrated no significant difference between mean value of elasticity in longitudinal and transverse directions. (p value = 0.47 and 0.86, respectively). Correlation analysis revealed that the higher the McGill pain score, the lower the elasticity.(correlation coefficient = -0.647, p value = 0.009)
Conclusion
The elasticity measured in patients with unilateral MPS did not show statistically significant differences between the symptomatic and intact side, which might be due to the high percentage of chronic MPS patients. Chronic patients developed wider muscle disruption than the tender point and decreased propagational velocity measured by shearwave. In conclusion, even if symptoms develop in uniltaeral trapezius, the range of subclinical muscle disruption increases with chronic progression to stiffness of both trapezius. Self-exercises performed in patients with chronic trapezius MPS should be educated to stretch not only symptomatic side, but also intact side. |
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Transverse view on ultrasound depicting the right upper trapezius, showing a slightly increased thickness on the symptomatic side.
Transverse B-mode image (left) shows symptomatic upper trapezius muscle. Corresponding color elastogram (right) shows homogeneous blue color elasticity signal (blue ROI; Mean 26.1kPa, Diameter 0.3cm, RMI 0.8)
Correlation between McGuill Pain Questiaonnaire and SWV(Shear Wave Velocity)
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