Two- and three-dimensional ultrasound imaging to facilitate detection and targeting of taut bands in myofascial pain syndrome.
BACKGROUND
Ultrasound imaging has gained acceptance in pain management interventions. Features of myofascial pain syndrome have been explored using ultrasound imaging and elastography. There is a paucity of reports showing the benefit clinically. This report provides three-dimensional features of taut bands and highlights the advantages of using two-dimensional ultrasound imaging to improve targeting of taut bands in deeper locations.


METHODS
Fifty-eight-year-old man with pain and decreased range of motion of the right shoulder was referred for further management of pain above the scapula after having failed conservative management for myofascial pain syndrome. Three-dimensional ultrasound images provided evidence of aberrancy in the architecture of the muscle fascicles around the taut bands compared to the adjacent normal muscle tissue during serial sectioning of the accrued image. On two-dimensional ultrasound imaging over the palpated taut band, areas of hyperechogenicity were visualized in the trapezius and supraspinatus muscles. Subsequently, the patient received ultrasound-guided real-time lidocaine injections to the trigger points with successful resolution of symptoms.


CONCLUSIONS
This is a successful demonstration of utility of ultrasound imaging of taut bands in the management of myofascial pain syndrome. Utility of this imaging modality in myofascial pain syndrome requires further clinical validation.
Department of Anesthesiology, Clement Zablocki VA Medical Center & Medical College of Wisconsin, Milwaukee, WI, USA. hshankar@mcw.edu
Hariharan
H
Shankar
Sapna
S
Reddy
D000328:Adult; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005156:Facial Neuralgia / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D020069:Shoulder Pain / Q000000981:diagnostic imaging*; D061028:Trigger Points / Q000000981:diagnostic imaging*