No abstract available.
Female ; Humans ; Pectoralis Muscles/*diagnostic imaging ; Trigger Points/*diagnostic imaging ; Ultrasonography

OBJECTIVE: To compare the effect of pharmaceutic agents which were used in trigger point injection and to establish a relationship between ultrasonographic change in injected muscle and post-injection soreness by a double blinded study. METHOD: Twenty-seven patients who were diagnosed as myofascial pain syndrome with their trigger point in upper trapezius muscle were recruited. They were assigned to four groups by age and sex: lidocaine injection (n=8), normal saline injection (n=6), 20%dextrose injection (n=6), and BTX-A injection (n=7). One physiatrist palpated a trigger point at upper trapezius muscle and injected blinded agents with same volume (1 ml). Ultrasonography for injected muscle was done by 2 weeks after injection. Visual analog scale was evaluated up to twenty three weeks. RESULTS: Mean score of visual analog scale was decreased in all groups. Among the four agents, 0.5% lidocaine and BTX-A showed significant decrement in visual analog scale (p<0.05). Ultrasonographic depth of muscle was increased in BTX-A and 20% dextrose injected group at the end of injection (p<0.05). There were no significant different treatment effect in four pharmaceutic agents. CONCLUSION: In all four groups, trigger point injection showed therapeutic effect for myofascial pain syndrome. Among the four agents, 0.5% lidocaine and BTX-A could reduce pain significantly up to twenty three weeks. Mechanical pressure on muscle fiber was thought to be one of the causes of post-injection soreness.
Botulinum Toxins, Type A ; Glucose ; Humans ; Lidocaine ; Myofascial Pain Syndromes ; Superficial Back Muscles ; Trigger Points* ; Ultrasonography ; Visual Analog Scale

Since the myofascial trigger point(MFTrP) has been described fifty years ago, its underlying pathophysiology has been remained unclear. The diagnosis also depends on the characteristic pain, tenderness and physical findin gs, which is yery subjective. In recent years, some physicians investigated the objective findings of MFTrP, using the pressure algometer and thermography. We investigated the electromyographic findings of MFTrP to evaluate the clinical usefulness of local twitch response(LTR) and sympathetic skin response (SSR), and to evaluate the electrophysiologic characteristics of MFTrP. 21 patients, diagnosed as myofascial trigger point syndrome on upper trapezius and so on, were evaluated for the triggering pain with visual analog scale(VAS), pressure threshold(THpr) using pressure algometer(Dolorimeter), LTP with concentric needle electrode and SSR on the palm. There was a significant negative correlation between VAS and THpr, but no significant correlation with electromyographic findings of LTR. Thus LTR could support the existence of MFTrP electrodiagnostically, but, could not explain the clinically correlated severity of MFTrP. There were only 3 patients showing abnormal SSR, who were all complaining the sympathetic sympathetic symptoms on the affected arm with reffered pain. Even though referred pain to arm and hand existed. SSR was normal because suggested autonomic dysfunction of MFTrP is localized mechanism. Among the 13 patients underwent the trigger point block, 8 patients who showed no residual LTR immediate after MFTrP block, had a great symptomatic improvement of MFTrP in a week, but 5 patients who showed the residual LTR did not, Regardless of complaint of pain and soreness immediate after block, loss of LTR would be predicted as a good treatment result. In some cases, spontaneous EMG activity exist within the 3-4mm sized focus of MFTrP. although the taut band of MFTrP is 3-4cm length and depth. But this focus of MFTrP is a electrophysiologic changes within a muscle, not a structural changes seen by ultrasonography.
Arm ; Diagnosis ; Electrodes ; Electromyography ; Hand ; Humans ; Needles ; Pain, Referred ; Skin ; Superficial Back Muscles ; Thermography ; Trigger Points* ; Ultrasonography

OBJECTIVE: To investigate an appropriate depth of needle insertion during trigger point injection into the rhomboid major muscle. METHODS: Sixty-two patients who visited our department with shoulder or upper back pain participated in this study. The distance between the skin and the rhomboid major muscle (SM) and the distance between the skin and rib (SB) were measured using ultrasonography. The subjects were divided into 3 groups according to BMI: BMI less than 23 kg/m2 (underweight or normal group); 23 kg/m2 or more to less than 25 kg/m2 (overweight group); and 25 kg/m2 or more (obese group). The mean+/-standard deviation (SD) of SM and SB of each group were calculated. A range between mean+1 SD of SM and the mean-1 SD of SB was defined as a safe margin. RESULTS: The underweight or normal group's SM, SB, and the safe margin were 1.2+/-0.2, 2.1+/-0.4, and 1.4 to 1.7 cm, respectively. The overweight group's SM and SB were 1.4+/-0.2 and 2.4+/-0.9 cm, respectively. The safe margin could not be calculated for this group. The obese group's SM, SB, and the safe margin were 1.8+/-0.3, 2.7+/-0.5, and 2.1 to 2.2 cm, respectively. CONCLUSION: This study will help us to set the standard depth of safe needle insertion into the rhomboid major muscle in an effective manner without causing any complications.
Back Pain ; Humans ; Muscles ; Needles* ; Overweight ; Pneumothorax ; Ribs ; Shoulder ; Skin ; Superficial Back Muscles* ; Thinness ; Trigger Points* ; Ultrasonography

Myofascial pain syndrome (MPS) can be characterized by pain caused by trigger points (TrPs) and fascial constrictions. Patients with MPS of the gluteus minimus muscles often complain of symptoms such as hip pain, especially when standing up after sitting or lying on the affected side, limping, and pain radiating down to the lower extremities. A 24-year-old female patient presenting with motor and sensory impairments of both lower extremities was referred to our pain clinic after initially being diagnosed with lumbar radiculitis. Under the impression of MPS of the gluteus minimus muscles following through evaluation and physical examination of the patient, we performed trigger point injections under ultrasonography guidance on the myofascial TrPs. Dramatic improvement of the patient's symptoms was observed following this treatment, and she was discharged without any further remaining symptoms.
Constriction ; Deception ; Female ; Hip ; Humans ; Lower Extremity ; Muscles ; Myofascial Pain Syndromes* ; Pain Clinics ; Physical Examination ; Radiculopathy* ; Trigger Points ; Ultrasonography ; Young Adult

PURPOSE: Myofascial pain syndrome (MPS) is a common cause of musculoskeletal pain. Myofascial trigger points (MTrPs) have been repeatedly described by numerous authors. However, there have been few studies in which their existence and behavior was supported and their location confirmed. The purpose of this study was to determine whether diagnostic ultrasonography is an objective diagnostic tool which is able to significantly identify or detect the soft tissue changes in the region of clinically identified active MTrPs by using a rabbit experimental model. MATERIALS AND METHODS: Ten MPS model rabbits were used in this study. We made an MPS animal model by causing the rabbits to overuse one leg for 3 weeks by cutting the contralateral L4 spinal nerve root. We compared the ultrasonographic findings of the taut band at pre-OP with those at post-OP during the consecutive three week period. To find the taut bands of the muscle, after skin exposure, the muscles were gently rubbed or pinched with the thumb and index finger on the two opposing surfaces of the muscle across the direction of the fibers. Then, the muscle was held in the same way, but with a 5-8 MHz stick probe being used in place of the thumb. After the palpation of various muscles, we selected the hardest and largest myofascial trigger nodule, in order to observe the ultrasonographic and power Doppler findings of the MPS. The size, shape, echogenecity and vascularity of the MTrPs were observed. RESULTS: The analysis of the results of the ultrasonography revealed that all MTrPs have a hyperechoic area. The mean thickness of the hyperechoic lesion in the biceps was 0.96+/-0.14 cm in the MPS site (at pre-OP?), and 0.49+/-0.12 cm at post-OP 3weeks (p < 0.01). The hyperechoic lesions in all of the studied biceps femoris of the rabbits were observed by high resolution ultrasonography. No definitively decreased vascularity was observed within the hyperechoic area by power Doppler imaging. CONCLUSION: Until now, there has been no objective method for the diagnosis of MPS. However, this study suggests the possibility of using diagnostic ultrasonography as an objective diagnostic tool, by identifying the tissue changes in the region of clinically indicated active MTrPs.
Animals ; Diagnosis ; Fingers ; Leg ; Models, Animal ; Models, Theoretical ; Muscles ; Musculoskeletal Pain ; Myofascial Pain Syndromes* ; Palpation ; Rabbits ; Skin ; Spinal Nerve Roots ; Thumb ; Trigger Points* ; Ultrasonography

After slip down, a 64 years old female had pain on the left buttock and the back without weakness or sensory change. Physical examination revealed tender points on left buttock and quadratus lumborum muscle. Straight leg raising test was 40degrees/20degrees. After trigger point injection on tender points, her symptoms were improved. Magnetic resonance imaging showed central extruded disc at L3-S1. After systemic steroid therapy was started, fever was developed about 39.3degrees C and laboratory evaluation showed inflammatory sign. Systemic steroid injection was stopped. Physical examination revealed a palpable and painful mass on the left lower quadrant of the abdomen. Ultrasonography and computerized tomography of abdomen and pelvis showed a large (7x5 cm) irregular shaped cystic mass along left iliopsoas muscle. Percutaneous catheter was inserted for drainage. Thick turbid yellow-greenish pus (300 cc) was drained. Intravenous antibiotics were administered and the patient's symptoms gradually improved. Culture of the pus revealed Streptococcus agalactiae.
Abdomen ; Anti-Bacterial Agents ; Buttocks ; Catheters ; Drainage ; Female ; Fever ; Humans ; Leg ; Magnetic Resonance Imaging ; Middle Aged ; Pelvis ; Physical Examination ; Psoas Abscess* ; Streptococcus agalactiae ; Suppuration ; Trigger Points* ; Ultrasonography

OBJECTIVE: To investigate usefulness of surface electromyography (sEMG) for the pain evaluation in the patients with temporomandibular myofascial pain dysfunction syndrome (TM-MPDS). METHOD: Twenty unilateral TM-MPDS patients (10 males, 10 females, duration of disease 6.6+/-5.6 months, age 28.5+/-3.0 years) and twenty healthy controls (10 males, 10 females, age 30.1+/-6.2 years) were recruited for this study. The patients were treated with trigger point injection therapy and cryotherapy once a week, and ultrasound thermotherapy four times a week for 2 weeks. Active electrodes were attached on temporalis and masseter muscles with reference electrode on chin and ground electrode on forehead. All of subjects were instructed to clench teeth for 5 seconds after full relaxation. For temporalis and masseter muscles, the amplitudes of clenching-EMG activities were obtained and the mean value of five biting cycles was calculated on both sides. sEMG, visual analog scale (VAS) and asymmetry index (AI) were assessed before and 2 weeks after treatment. RESULTS: For temporalis and masseter muscles, the amplitudes of affected side-EMG activity significantly decreased, and the AI of the patient group significantly increased compared with those of the control group (p<0.05, p< 0.05). The AI of the patient group significantly decreased after treatment (p<0.05, p<0.05). Higher AI in masseter muscle before treatment was significantly correlated with lower VAS after treatment (r=-0.487, p<0.05). CONCLUSION: It is suggested that sEMG would be useful for diagnosing and evaluating the pain in TM-MPDS.
Chin ; Cryotherapy ; Electrodes ; Electromyography* ; Female ; Forehead ; Humans ; Hyperthermia, Induced ; Male ; Masseter Muscle ; Relaxation ; Temporomandibular Joint ; Tooth ; Trigger Points ; Ultrasonography ; Visual Analog Scale

OBJECTIVE: To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper arm pain. METHODS: A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS). RESULTS: US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (capital DE, CyrillicVAS=-2.8) was significantly larger than caused by oral NSAID (capital DE, CyrillicVAS=-1.5) (p<0.05). CONCLUSION: In patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of pain is suspected to be originated from the muscle.
Arm* ; Diagnosis ; Humans ; Myofascial Pain Syndromes ; Pilot Projects* ; Prospective Studies ; Rehabilitation ; Rotator Cuff* ; Shoulder Pain ; Trigger Points* ; Ultrasonography ; Visual Analog Scale

PURPOSE: To investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients. MATERIALS AND METHODS: This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. We performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method. RESULTS: Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline (p<0.05 for both). Duration from onset to surgery and duration of myofascial pain syndrome in the good responder group were significantly shorter than in the bad responder group (p<0.05). Patients did not report any complications related to the procedure or serious adverse events attributable to the treatment. CONCLUSION: In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.
Adult ; Aged ; Anesthetics, Local/administration & dosage/therapeutic use ; Female ; Humans ; Injections, Intramuscular/methods ; Lidocaine/administration & dosage/therapeutic use ; Mastectomy ; Middle Aged ; Muscle, Skeletal/drug effects/ultrasonography ; Myofascial Pain Syndromes/drug therapy ; Pectoralis Muscles/drug effects/*ultrasonography ; Trigger Points/*ultrasonography