title: A comparison between different modes of real-time sonoelastography in visualizing myofascial trigger points in low back muscles.
abstract: OBJECTIVE
  Currently, there is a lack of objective means to quantify myofascial trigger points (MTrPs) and their core features. Our research compares (1) MTrPs and surrounding myofascial tissue using two-dimensional grayscale ultrasound (2DGSUS) and vibration sonoelastography (VSE); (2) the accuracy of both modes in visualizing MTrPs; (3) 'active' and 'latent' MTrPs, using VSE; and (4) the accuracy of both modes in visualizing deep and superficially located MTrPs.
  
  
  METHODS
  Fifty participants with more than two MTrPs in their quadratus lumborum, longissimus thoracis, piriformis, and gluteus medius muscles were assigned to an active MTrP (low back pain) group or a latent (currently pain free) MTrP group. MTrP identification was based on their essential criteria. An electronic algometer measured repeatedly the tenderness of MTrPs with reference to pressure pain threshold values. A handheld vibrator was applied over MTrPs, while VSE and 2DGSUS readings were taken using an EUB-7500 ultrasound scanner.
  
  
  RESULTS
  There was a significant difference between MTrP strain and that of the immediately surrounding myofascial tissue, as measured using VSE (P= 0·001). VSE visualized all superficial and deep MTrPs with an accuracy of 100% (for both groups); the blinded results obtained using 2DGSUS achieved 33% and 35% accuracy, respectively. There was no significant difference found between the tissue strain ratios of active and latent MTrPs (P= 0·929).
  
  
  CONCLUSIONS
  Sonoelastography can visualize superficial and deep MTrPs, and differentiate them from surrounding myofascial structure through tissue stiffness and echogenicity. VSE was more accurate than 2DGSUS in visualizing and imaging MTrPs.
authors.affiliation: Department of Basic Sciences, School of Physical Therapy, Cairo University, Egypt.
authors.forename: Mary Kamal Nassif
authors.initials: MK
authors.lastname: Takla
authors.affiliation: Department of Radiology, School of Medicine, Cairo University, Egypt.
authors.forename: Naglaa Mohamed Abdel
authors.initials: NM
authors.lastname: Razek
authors.affiliation: Department of Basic Sciences, School of Physical Therapy, Cairo University, Egypt.
authors.forename: Omaima
authors.initials: O
authors.lastname: Kattabei
authors.affiliation: Department of Basic Sciences, School of Physical Therapy, Cairo University, Egypt.
authors.forename: Marzouk Abdel Fattah
authors.initials: MA
authors.lastname: El-Lythy
keywords: Low back pain; Myofascial trigger points; Two-dimensional grayscale ultrasound; Vibration sonoelastography