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

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

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

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 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

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

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

Most people experience episodes of low back pain that are usually brief, resolve spontaneously, and recur infrequently. The successful management of persistent low back pain requires that the treatment be directed to the pain-producing structures in the human body. The treatment of low back pain ranges from very simple and straight forward managements to very complex and intricate ones. Treatments for lumbar disc herniations can be conservative (75~90% of patients), invasive (5~10% of patients), or surgical (5% of patients). Resolution of the first lumbar disc herniation takes place in approximately 75% of patients over a period of 3 months. With recurrent herniations, the chance of spontaneous relief of symptoms decreases. In a very acute stage, the patients may require hospitalization to control the level of pain. Bed rest should be limited for 2 days with the most comfortable position of the knee and the hip flexion at about 80~90 degrees. A few days of bed rest, adequate analgesics, and muscle relaxants to reduce muscle spasm are usually required. Physical therapeutic modalities (including traction, heat, ultrasound, and electrical stimulation), mobilization, manipulation, back school, spinal supports, therapeutic exercise and proper position should be used and educated. If the low back pain is not controlled after these treatments, invasive procedures such as trigger point injection, facet or sacroiliac joint injection, epidural steroid injection, selective nerve root injection with high frequency heat therapy, or intradiscal injection may be implemented to alleviate the symptoms rapidly. Every patient should attend a class for spine education as part of the comprehensive management. Instructions should be given for low back care, especially as related to the activities of daily living. Participants will learn correct postures, pelvic tilting, knee-to-chest exercise, and exercises to strengthen abdominal and paraspinal muscles. Individual instructions are given to each patient, detailing the nature of the patient's particular problem and how he or she can make the best of the treatment.
Activities of Daily Living ; Analgesics ; Bed Rest ; Education ; Exercise* ; Hip ; Hospitalization ; Hot Temperature ; Human Body ; Humans ; Injections, Epidural ; Knee ; Low Back Pain ; Pain Management* ; Paraspinal Muscles ; Posture ; Sacroiliac Joint ; Spasm ; Spine ; Traction ; Trigger Points ; Ultrasonography