Abstract
Since manual palpation is a subjective procedure for identifying and differentiate Myofascial Trigger Points -MTrPs-, the use of Shear Wave Elastography -SWE- as an objective alternative is increasing. This study aimed to analyze pain pressure thresholds -PPTs- and SWE differences between active MTrPs, latent MTrPs and control points located in the upper trapezius to analyze the association of SWE features with clinical severity indicators (e.g., pain extension area, PPTs, neck pain and neck disability). An observational study was conducted to calculate the correlation and to analyze the differences of sociodemographic, clinical and SWE features on 34 asymptomatic subjects with latent MTrPs and 19 patients with neck pain and active MTrPs. Significant PPT differences between active with latent MTrPs (p < 0.001) and control points (p < 0.001) were found, but no differences between latent MTrPs and control points (p > 0.05). No stiffness differences were found between active MTrPs with latent MTrPs or control points (p > 0.05). However, significant control point stiffness differences between-samples were found (p < 0.05). SWE showed no significant correlation with clinical severity indicators (p > 0.05). No stiffness differences between active and latent MTrPs were found. Neck pain patients showed increased control point stiffness compared with asymptomatic subjects. SWE showed no association with clinical severity indicators.
Highlights
Neck pain is the fourth highest condition on number of years lived with disability with a 20% of estimated prevalence, a lifetime prevalence up to the 70% and high recurrence [1].Current evidence suggests that a higher prevalence of Myofascial Trigger Points -MTrPin the upper quarter muscles could be found in patients with chronic neck pain compared with healthy controls [2,3].A MTrP is defined as “a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band
All neck pain patients (n = 19) showed bilateral active MTrP located in the upper trapezius
In this study, (1) we compared the stiffness of neck pain patients with active MTrPs with asymptomatic subjects with latent MTrPs, (2) we compared the stiffness of both latent and active MTrPs with control points and (3) we conducted a correlation analysis between stiffness assessed as Young modulus and shear wave speed and clinical severity assessed as pain intensity, pain sensitivity, disability and pain extent
Summary
A MTrP is defined as “a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band This spot is painful on manual compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction and autonomic phenomena” and could be classified as active (upon stimulation reproduce any symptom experienced by the patient, either partially or completely, whereby the symptom is recognized as a familiar experience by the patient, even though it may not be present at the moment of the examination) or latent (upon stimulation do not reproduce any symptom experienced by a subject, symptomatic or asymptomatic, and the subject does not recognize the elicited symptom as familiar) based on previous histological, neurophysiological, biochemical, sonographic and somatosensorial findings [4,5]. It has been found that the prevalence and pain sensitivity of MTrPs are enough sensitive to make distinctions between patients with chronic non-traumatic neck pain and healthy subjects, the evidence supporting the high prevalence of active and latent MTrPs in patients with neck pain is based on few studies with small sample sizes and design limitations [1]
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