title: Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue.
abstract: OBJECTIVE
  To apply ultrasound (US) imaging techniques to better describe the characteristics of myofascial trigger points (MTrPs) and the immediately adjacent soft tissue.
  
  
  METHODS
  Four sites in each patient were labeled based on physical examination as active myofascial trigger points (A-MTrPs; spontaneously painful), latent myofascial trigger points (L-MTrPs; nonpainful), or normal myofascial tissue. US examination was performed on each subject by a team blinded to the physical findings. A 12 approximately 5MHz US transducer was used. Vibration sonoelastography (VSE) was performed by color Doppler variance imaging while simultaneously inducing vibrations (approximately 92Hz) with a handheld massage vibrator. Each site was assigned a tissue imaging score as follows: 0, uniform echogenicity and stiffness; 1, focal hypoechoic region with stiff nodule; 2, multiple hypoechoic regions with stiff nodules. Blood flow in the neighborhood of MTrPs was assessed using Doppler imaging. Each site was assigned a blood flow waveform score as follows: 0, normal arterial flow in muscle; 1, elevated diastolic flow; 2, high-resistance flow waveform with retrograde diastolic flow.
  
  
  METHODS
  Biomedical research center.
  
  
  METHODS
  Subjects (N=9) meeting Travell and Simons' criteria for MTrPs in a taut band in the upper trapezius.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  MTrPs were evaluated by (1) physical examination, (2) pressure algometry, and (3) three types of US imaging including gray-scale (2-dimensional [2D] US), VSE, and Doppler.
  
  
  RESULTS
  MTrPs appeared as focal, hypoechoic regions on 2D US, indicating local changes in tissue echogenicity, and as focal regions of reduced vibration amplitude on VSE, indicating a localized, stiff nodule. MTrPs were elliptical, with a size of .16+/-.11 cm(2). There were no significant differences in size between A-MTrPs and L-MTrPs. Sites containing MTrPs were more likely to have a higher tissue imaging score compared with normal myofascial tissue (P<.002). Small arteries (or enlarged arterioles) near A-MTrPs showed retrograde flow in diastole, indicating a highly resistive vascular bed. A-MTrP sites were more likely to have a higher blood flow score compared with L-MTrPs (P<.021).
  
  
  CONCLUSIONS
  Preliminary findings show that, under the conditions of this investigation, US imaging techniques can be used to distinguish myofascial tissue containing MTrPs from normal myofascial tissue (lacking trigger points). US enables visualization and some characterization of MTrPs and adjacent soft tissue.
authors.affiliation: Department of Electrical and Computer Engineering, George Mason University, 4400 University Dr, MS 1G5, Fairfax, VA 22030, USA. ssikdar@gmu.edu
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Sikdar
authors.forename: Jay P
authors.initials: JP
authors.lastname: Shah
authors.forename: Tadesse
authors.initials: T
authors.lastname: Gebreab
authors.forename: Ru-Huey
authors.initials: RH
authors.lastname: Yen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gilliams
authors.forename: Jerome
authors.initials: J
authors.lastname: Danoff
authors.forename: Lynn H
authors.initials: LH
authors.lastname: Gerber
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply*; D009209:Myofascial Pain Syndromes / Q000000981:diagnostic imaging*; D010812:Physical Stimulation / Q000379:methods*; D018709:Statistics, Nonparametric; D014159:Transducers; D018608:Ultrasonography, Doppler / Q000379:methods*; D014732:Vibration