Application of ultrasound-guided trigger point injection for myofascial trigger points in the subscapularis and pectoralis muscles to post-mastectomy patients: a pilot study.
OBJECTIVE
To investigate the therapeutic effectiveness of ultrasound (US)-guided trigger point injection for myofascial trigger points (MTrPs) in the internal rotator muscles of the shoulder in post-mastectomy patients.


METHODS
This pilot study was a non-controlled, prospective, clinical trial. Nineteen post-mastectomy patients with a diagnosis of at least one active MTrP in the subscapularis and/or pectoralis muscles were included. We performed trigger point injections into the subscapularis muscle deep behind the scapula as well as the pectoralis muscle for diagnostic and therapeutic purpose by the newly developed US-guided method.


RESULTS
Visual analogue scale and range of motion of the shoulder for external rotation and of abduction showed significant improvement immediately after the first injection and 3 months after the last injection compared with baseline (p<0.05 for both). Duration from onset to surgery and duration of myofascial pain syndrome in the good responder group were significantly shorter than in the bad responder group (p<0.05). Patients did not report any complications related to the procedure or serious adverse events attributable to the treatment.


CONCLUSIONS
In post-mastectomy patients with shoulder pain, US-guided trigger point injections of the subscapularis and/or pectoralis muscles are effective for both diagnosis and treatment when the cause of shoulder pain is suspected to originate from active MTrPs in these muscles, particularly, the subscapularis.
Department of General Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
Hyuk Jai
HJ
Shin
Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
Ji Cheol
JC
Shin
Department of General Surgery, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea.
Wan Sung
WS
Kim
Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Won Hyuk
WH
Chang
Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea.
Sang Chul
SC
Lee
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008408:Mastectomy; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000187:drug effects; D009209:Myofascial Pain Syndromes / Q000188:drug therapy; D010369:Pectoralis Muscles / Q000000981:diagnostic imaging* / Q000187:drug effects; D061028:Trigger Points / Q000000981:diagnostic imaging*; D014463:Ultrasonography
D000779:Anesthetics, Local; D008012:Lidocaine
Myofascial pain syndrome; breast cancer; pain; trigger points; ultrasound