Myofascial trigger point induce myofascial pain and remain a challenge to diagnose and treat.
Do you use ultrasonography to localize trigger points?
if so, what kind of device and transducer?
I don´t but I´d be very interested in knowing the technical details and the specificity and characteristics of the imaging. Thanks!
No. I would not consider using a procedure in clinical practice before there is evidence that it is actually useful.
No because it's not necessary as they can easily be palpated but of course it would be interesting if they could be identified objectively as well.
Usually we don’t use US imaging techniques for distinguish myofascial tissue containing myofascial trigger points . But please check
Sikdar S. et al. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil. 2009,90(11):1829-38.
Dear Philippe,
since trigger points has its own referral pain zone and its easily palpable nature ultrasonography is not used commonly .you can refer the article "Clinical Comparative Study for Ultrasound-Guided Trigger-Point Needling for Myofascial PainMedical Acupuncture. December 2013, Vol. 25, No. 6: 437-443"
Of course, it is very useful but you need an special program of ultrasound technology called vibration sonoelastography in combination with Doppler. If yuo don´t have this special program you can use the resistive index, RI, that is commonly used for vascular diagnosis and is defined as the ratio of the difference in peak systolic and minimum diastolic velocities to the peak systolic velocity, and is an indication of the resistance of the end-organ vascular bed. In muscle, normally RI=1, indicating no diastolic flow. Elevated diastolic flow (RI
This discussion is getting more and more interesting. May I ask you what is the pathomorphological substrate of a myofascial trigger point ? If this is clear enough then we can apply methods to determine its localization and to inhibit its activity.
Dear Colleagues,
First thank you for your answers to my question
Dear P. Tanchev,
My ideas about Muscle Trigger Points (MTrPs) is that they come with muscles overuse or trauma. The TrP is hypoxic with low pH inducing pain, motor weakness and autonomic reactions.
They are easy to localize in superficial muscles (trapezius, infraspinatus...), but more difficult in some areas like pterygoïds, piriformis and pelvic muscles. In my opinion, echography may help the clinicians (beginners like me) to make diagnosis in these specific locations and usefull to use dry needling technique (avoid vascular or nerve puncture near the scalenes for example).
Echography may a good thing to teach about Myofascial Pain and to conduct homogeneous studies.
Hope it will help, All the best, Ph. Rault
Great question!
Irrespective of the theoretical constructs thought to explain palpable tender and painful TrP, pragmatically speaking, the majority of TrP are palpable and if away from NVBs may be easily injected (dry needling or a caine to diminish action potential along type C nociceptive fiber. Certainly, if TrP is deeper and/or near to NVB then US guidance may help avoid inadvertent injury.. A neurologist in San DIego published over 20 yrs ago single fiber needle EMG to locate that part of the TrP area where instillation of liquid phentolamine would block and diminish or resolve the TrP up to a year. It was in a Journal of Musculoskeletal Medicine. As the drug is essentially useful in orphan disease of pheochromocytoma, the company (? Berlinger) opted not to continue with multicenter studies to try and replicate the work. Too bad , as this is such a devastating and common problem for individuals and oral analgesics, NSAID, opioids, muscle relaxants he minimal or transient effects at best for most suffers and rarely enhance resumption of previous work activities nor recreational activities.
Dear Phillipe, I am studying the issue of use US imaging for TrPs about 10 years, pls find my papers in this field.
http://www.epmajournal.com/content/3/1/13
https://www.researchgate.net/publication/51044452_The_use_of_trigger_point_dry_needling_under_ultrasound_guidance_for_the_treatment_of_myofascial_pain_%28technological_innovation_and_literature_review%29
Hope it will be helpful in your research. Best wishes, Rostyslav
Article The use of trigger point “dry” needling under ultrasound gui...
At present, we can´t ignore the US guided interfascial block witch probably will change the current concepts of the pathophysiology of this common problem.
Dear karar Abdul zahra,
To illustrate my point of view, I recommend this reference:
Domingo T, Blasi J, Casals, Mayoral V, Ortiz-Sagrista JC, Miguel-Perez M. Is Interfascial Block With Ultrasound-guided Puncture Useful in Treatment of Myofascial Pain of the Trapezius Muscle? Clin J Pain 2011;27:297–303.
Trigger points are very simply detected with the finger. Why should ultrasonography be necessary? This would only complicate the procedure.
Of course, Giustino. It´s easy for a skillful professional to detect with palpation superficial trigger points, but if these trigger points are deeper, ultrasound could very helpful and a good tool. And if you are a investigator you need something more to demostrate your findings. In clinical practice, in the majoriy of cases, it´s not required a unltrasound to get your right purpose.
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