Trigger points and ultrasound elastography strain ratio in young adults with head, neck and shoulder myofascial pain

Orientador: Maria Beatriz Duarte GaviãoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A dor crônica associada aos tecidos moles e a dor miofascial são responsáveis por grande impacto na função do organismo, gerando incapacidade, determinada pela presença de pontos-gatilho (PGs). A cefaleia do tipo tensão (CTT) é a dor de cabeça mais frequente em adultos, comumente relacionada à presença de PGs nos músculos da cabeça e pescoço. Novas tecnologias vêm sendo testadas para o diagnóstico complementar de PGs, tais como a ultrassonografia bidimensional em escala de cinza e a elastografia ultrassonográfica (ELASTO). Assim, o objetivo do presente estudo foi acessar os dados clínicos de adultos jovens com o olhar voltado para a frequência de PGs e a rigidez muscular relacionadas à dor de origem miofascial das regiões de cabeça, pescoço e ombros. Um estudo observacional transversal foi conduzido, sendo a amostra composta por 15 homens e 17 mulheres, com idades entre 19 e 35 anos (25,78±3,93), IMC de 18,07 a 29,98 kg/m2 (23,00±3,22). Os dados coletados foram: informações gerais, imagens pela ultrassonografia bidimensional em escala de cinza, índice de resistência (IR) através da ELASTO, limiar de dor à pressão (LDP) através da algometria digital, intensidade de dor através da Escala Visual Analógica (EVA), palpação manual de PGs e classificação da CTT. Nos resultados, as mulheres apresentaram maior frequência de dor em outras partes do corpo do que os homens e maior intensidade de dor pela EVA. O LDP foi significativamente menor no grupo com presença de PGs ativos do que no grupo com PGs latentes, para os músculos trapézios direito e esquerdo. O LDP no músculo trapézio esquerdo mostrou-se menor no grupo com PGs ativos, apresentando também maiores valores de IR, indicando aumento de rigidez nos músculos com maior sensibilidade à pressão. O presente estudo demonstrou que as mulheres com dor de origem miofascial sentem-na com maior intensidade e em maior número de outras partes do corpo em relação aos homens. A ELASTO e a algometria foram eficazes na identificação de maior rigidez muscular e menor LDP em músculos com presença de PGs ativosAbstract: Chronic soft tissue pain syndromes and myofascial pain are responsible for serious impact on function and disability, which are determined by the presence of myofascial trigger points (MTrP). Tension-type headache (TTH) is the most frequent headache in adults in often associated with MTrP of head and neck muscles. New features have been tested for MTrP complementary diagnosis, such as two-dimensional ultrasonography and ultrasound elastography (ELASTO). The aim of this study was to access clinical outcomes from young adults looking forward the frequency of MTrP and muscle tenderness related to pain complaints of myofascial origin on the head, neck and shoulders regions. An observational cross-section study was carried on, with the sample consisted of 15 men and 17 women, aged between 19 and 35 years (25.78±3.93), BMI of 18.07 to 29,98 Kg/m2 (23.00±3.22). Data were collected concerning general info, two-dimensional ultrasound, ELASTO strain ratio (SR), pain pressure threshold (PPT) trough digital algometer, pain intensity trough Visual Analogue Scale (VAS), manual palpation of MTrP and TTH classification. Women had statistically significant more pain in other parts of the body than men and higher pain intensity through VAS. PPT was significantly lower in active than latent MTrP group for both right and left trapezius. PPT in the left trapezius muscle were lower and concerning SR, statistically significant higher values were found in the active MTrP group, indicating that the most sensitive muscle presented the highest stiffness. Women with pain of myofascial origin felt it in greater intensity and associated with other parts of the body frequently than men. ELASTO and algometry were effective in greater muscle stiffness and lower PPT values identification in muscles with active MTrPDoutoradoAnatomiaDoutora em Biologia Buco-Denta

Two-dimensional ultrasound and ultrasound elastography imaging of trigger points in women with myofascial pain syndrome treated by acupuncture and electroacupuncture: a double-blinded randomized controlled pilot study

Chronic pain has been often associated with myofascial pain syndrome (MPS), which is determined by myofascial trigger points (MTrP). New features have been tested for MTrP diagnosis. The aim of this study was to evaluate two-dimensional ultrasonography (2D US) and ultrasound elastography (UE) images and elastograms of upper trapezius MTrP during electroacupuncture (EA) and acupuncture (AC) treatment. 24 women participated, aged between 20 and 40 years (M ± SD = 27.33 ± 5.05) with a body mass index ranging from 18.03 to 27.59 kg/m2 (22.59 ± 3.11), a regular menstrual cycle, at least one active MTrP at both right (RTPz) and left trapezius (LTPz) and local or referred pain for up to six months. Subjects were randomized into EA and AC treatment groups and the control sham AC (SHAM) group. Intensity of pain was assessed by visual analogue scale; MTrP mean area and strain ratio (SR) by 2D US and UE. A significant decrease of intensity in general, RTPz, and LTPz pain was observed in the EA group (p = 0.027; p < 0.001; p = 0.005, respectively) and in general pain in the AC group (p < 0.001). Decreased MTrP area in RTPz and LTPz were observed in AC (p < 0.001) and EA groups (RTPz, p = 0.003; LTPz, p = 0.005). Post-treatment SR in RTPz and LTPz was lower than pre-treatment in both treatment groups. 2D US and UE effectively characterized MTrP and surrounding tissue, pointing to the possibility of objective confirmation of subjective EA and AC treatment effects.372152167COORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPSem informação2011/12659-

Two-dimensional Ultrasound And Ultrasound Elastography Imaging Of Trigger Points In Women With Myofascial Pain Syndrome Treated By Acupuncture And Electroacupuncture: A Double-blinded Randomized Controlled Pilot Study.

Chronic pain has been often associated with myofascial pain syndrome (MPS), which is determined by myofascial trigger points (MTrP). New features have been tested for MTrP diagnosis. The aim of this study was to evaluate two-dimensional ultrasonography (2D US) and ultrasound elastography (UE) images and elastograms of upper trapezius MTrP during electroacupuncture (EA) and acupuncture (AC) treatment. 24 women participated, aged between 20 and 40 years (M ± SD = 27.33 ± 5.05) with a body mass index ranging from 18.03 to 27.59 kg/m2 (22.59 ± 3.11), a regular menstrual cycle, at least one active MTrP at both right (RTPz) and left trapezius (LTPz) and local or referred pain for up to six months. Subjects were randomized into EA and AC treatment groups and the control sham AC (SHAM) group. Intensity of pain was assessed by visual analogue scale; MTrP mean area and strain ratio (SR) by 2D US and UE. A significant decrease of intensity in general, RTPz, and LTPz pain was observed in the EA group (p = 0.027; p < 0.001; p = 0.005, respectively) and in general pain in the AC group (p < 0.001). Decreased MTrP area in RTPz and LTPz were observed in AC (p < 0.001) and EA groups (RTPz, p = 0.003; LTPz, p = 0.005). Post-treatment SR in RTPz and LTPz was lower than pre-treatment in both treatment groups. 2D US and UE effectively characterized MTrP and surrounding tissue, pointing to the possibility of objective confirmation of subjective EA and AC treatment effects.37152-6