scholarly journals POS1284 FASCIAL ULTRASOUND: THE CONTEXT FOR DRY NEEDLING TRIGGER POINTS IN TREATMENT OF MYOFASCIAL PAIN, POSTURAL IMBALANCE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 924.3-925
Author(s):  
R. Bubnov ◽  
L. Kalika
Keyword(s):  
Rheumatic Diseases ◽  
Ultrasound Guidance ◽  
Myofascial Pain ◽  
Treatment Effectiveness ◽  
Pain Treatment ◽  
Trigger Points ◽  
Low Back ◽  
Dry Needling ◽  
Link Type ◽  
Postural Imbalance

Background:Muscles and fascia are the major source of pain in rheumatic diseases. Dry needling under ultrasound guidance (DN-US) is a crucial therapeutic approach to treat muscle pain [1,2], the definition `myo-fascial` calls for searching trigger points (TrPs) in fascia to improve the treatment effectiveness.Objectives:Aim was to evaluate the relevance of fascial ultrasound for DN-US in myo-fascial pain.Methods:We included 36 patients (21 females, 20-69 years old) with myofascial pain different localisations (low back, limbs, shoulder, neck pain), postural imbalance; did DN-US protocol according to R. Bubnov [1]: trigger points were identified according, fine (28G) steel needle DN-US was applied. Additionally considered fascial structures for detecting areas of abnormalities (hypervascularity, heterogeinity, hypomotility, adhesions) aka `trigger points` and potental nerve compression/irritation and did precise DN-US where appropriate.Results:In all patients movement restored and pain decreaed after muscles DN; in 30 patients additionally we detected and did successful DN-US the major fascial points as follows: thoracolumbar fascia, sacroiliac joint, pelvis ligaments, rotator cuff; potential nerve compressions (e.g., arcade of Frochse, soleus arcade); nerve sheath surrounding nerves (sciatic nerve, brachial plexus) and vessels (thoracic outlet syndrome), smaller fascia, joint capsule thickening. We detected higher rates of motility, improvement postural balance and pain decrease, fewer sessions needed in patients after extensive protocol.Conclusion:Fascia dry needling is accessible and effective method for myo-fascial pain treatment, may provide additional mechanical benefit and help to maintain treatment effect. Affected fascia can be considered as relevant trigger points, specific ultrasound symptoms should be validated.References:[1]Bubnov R Trigger Points Dry Needling Under Ultrasound Guidance for Low Back Pain Therapy. Comparative Study. Annals of the Rheumatic Diseases2015;74:624. http://dx.doi.org/10.1136/annrheumdis-2015-eular.2323[2]Bubnov R, Kalika L, Babenko L. Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine. Annals of the Rheumatic Diseases 2018;77:1699. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3949Disclosure of Interests:None declared

scholarly journals AB0961 MYOFASCIAL TRIGGER POINTS ARE THE UNDEREVALUATED HYPOXIC NISCHES ALTERING POSTURE AND PHENOTYPE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1777.1-1777
Author(s):  
R. Bubnov ◽  
O. Golubnitschaja
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Rheumatic Diseases ◽  
Myofascial Pain ◽  
Low Back ◽  
Dry Needling ◽  
Flammer Syndrome ◽  
Myofascial Trigger Points ◽  
Us Guidance ◽  
Pattern Size

Objectives:Myofascial trigger point (MTrP) is a pillar pathophysiological unit in development of myofascial pain [1] and postural imbalance [2]. Dry needling (DN) of MTrP under ultrasound (US) guidance is prioritized method for treatment myofascial pain. Hypoxia-related signaling pathways play important role in development of rheumatic diseases and cancer [3,4].Hypothesis:MTrP are spastic hypovascularized hypoxic low energy areas that can produce organismic signaling, associated with niches in Flammer syndrome [3,4].Objectives:The aimwas to evaluate structure of MTrP in regard to stiffness and “ischemic pattern” before and after DN.Methods:We included 40 patients (26 females, aged 18–68 y.o.) with low back pain. Healthy 20 individuals (aged 18–52 y.o.) were controls. All patients underwent general exam, MRI, precise physical tests, extensive functional multiparameter neuromuscular US including M-mode, elastography (SWE), B-Flow (LOGIC E9 GE) of multifidus muscles. Then patients received DN of detected MTrP under US guidance.Results:We successfully detected MTrP as hypoechoic, stiff and hypovascular small areas with different patterns of decreasing motility, contractility (muscle contracted/rested thickness) in all patient and did precise DN. After DN muscle structure improved, motility, contractility restored, VAS scores changed from 7.4 to 2.3 (p <0.05). SWE was 11±6 kPa in MTrP (27 kPa in active, 5-8 kPa in latent MTrP) vs 3.8±0.3 kPa in controls and decreased to 4±0.4 kPa after treatment. Hypovascularity (“ischemic pattern”) size decreased from 3-4 mm to 0-1.5 mm, correlated with muscle function. Preliminary we found MTrP with more expressed hypovascular pattern, higher sensitivity and retaining levels of in individuals lower BMI and patient with Flammer phenotype [3,4] (13-15/15 positive responses to questionnaire).Conclusion:MTrP are stiff and most likely hypoxic areas, parameters improved after precise DN. US hunting for “ischemic pattern” markers can be important for patient stratification and targeted treatment and prevention. Metabolic profiling including HIF signaling, proteomic data collecting needed for further investigation for effective patients stratification. For the follow-up studies a correlation of the Flammer syndrome phenotype with individualised profiles of patients and diagnosed ischaemic patterns is recommended.References:[1]Bubnov RV: Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J 2012; 3(1):13.[2]Bubnov R, Kalika L. EFFECTIVE RESTORING MOTION AND EFFECTIVE TREATMENT OF MYOFASCIAL AND NEUROPATHIC LOW BACK PAIN BY TARGETED DRY NEEDLING USING ULTRASOUND GUIDANCE. Annals of the Rheumatic Diseases 2019;78:1921-1922.http://dx.doi.org/10.1136/annrheumdis-2019-eular.5533[3]Flammer Syndrome: From Phenotype to Associated Pathologies, Prediction, Prevention and Personalisation. Ed. by Olga Golubnitschaja. Springer International Publishing, 2019: 340.4.Bubnov R, Polivka J, Zubor P, Konieczka K, Golubnitschaja O. “Pre-metastatic niches” in breast cancer: are they created by or prior to the tumour onset? “Flammer syndrome” relevance to address the question. EPMA J. 2017;8(2):141–57.Disclosure of Interests:None declared

Ultrasound Guided Trigger Point Injections in Myofascial Pain Syndrome

2015 ◽  
Vol 26 (3) ◽  
pp. 82-84
Author(s):  
Shiva Prasad ◽  
Vijay LNU ◽  
Gururaj Bangari ◽  
Priyanka Patil ◽  
Spurti N Sagar
Keyword(s):  
Skeletal Muscles ◽  
Ultrasound Guidance ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Pain Syndrome ◽  
Myofascial Pain Syndrome ◽  
Trigger Points ◽  
Dry Needling ◽  
Deep Tissue ◽  
Repetitive Trauma

Abstract Trigger points as a cause of musculoskeletal or myofascial pain syndrome is well documented. Trigger points (Tr Ps) are tender and hypersensitive nodules seen in skeletal muscles which develop as a result of sudden or repetitive trauma to the muscles. They cause contractile state of a muscle with local or radiating pain. Active trigger points cause intense pain with limitation of movements of the muscles. The treatment involves deactivating the trigger points, usually done by various methods. Most common practice is myotherapy which involves deep tissue massage which is painful and time consuming. Dry needling and needling with anaesthetic injaection have been successfully used by many. Recently, ultrasound guidance is used to locate the trigger points and to accurately place the needle in to them to deactivate, thus preventing complications of blind procedures.

scholarly journals Effectiveness between Dry Needling and Ischemic Compression in the Triceps Surae Latent Myofascial Trigger Points of Triathletes on Pressure Pain Threshold and Thermography: A Single Blinded Randomized Clinical Trial

2019 ◽  
Vol 8 (10) ◽  
pp. 1632 ◽  
Author(s):  
Benito-de-Pedro ◽  
Becerro-de-Bengoa-Vallejo ◽  
Losa-Iglesias ◽  
Rodríguez-Sanz ◽  
López-López ◽  
...  
Keyword(s):  
Skin Temperature ◽  
Pain Threshold ◽  
Myofascial Pain ◽  
Pressure Pain Threshold ◽  
Pain Syndrome ◽  
Trigger Points ◽  
Triceps Surae ◽  
Dry Needling ◽  
Myofascial Trigger Points ◽  
Pressure Pain

Background: Deep dry needling (DDN) and ischemic compression technic (ICT) may be considered as interventions used for the treatment of Myofascial Pain Syndrome (MPS) in latent myofascial trigger points (MTrPs). The immediate effectiveness of both DDN and ICT on pressure pain threshold (PPT) and skin temperature of the latent MTrPs of the triceps surae has not yet been determined, especially in athletes due to their treatment requirements during training and competition. Objective: To compare the immediate efficacy between DDN and ICT in the latent MTrPs of triathletes considering PPT and thermography measurements. Method: A total sample of 34 triathletes was divided into two groups: DDN and ICT. The triathletes only received a treatment session of DDN (n = 17) or ICT (n = 17). PPT and skin temperature of the selected latent MTrPs were assessed before and after treatment. Results: Statistically significant differences between both groups were shown after treatment, showing a PPT reduction (p < 0.05) in the DDN group, while PPT values were maintained in the ICT group. There were not statistically significant differences (p > 0.05) for thermographic values before and treatment for both interventions. Conclusions: Findings of this study suggested that ICT could be more advisable than DDN regarding latent MTrPs local mechanosensitivity immediately after treatment due to the requirements of training and competition in athletes’ population. Nevertheless, further studies comparing both interventions in the long term should be carried out in this specific population due to the possible influence of delayed onset muscle soreness and muscle damage on PPT and thermography values secondary to the high level of training and competition.

Dry-Needling is Effective in Treating Active Myofascial Trigger Points in Subjects with Chronic Myofascial Pain: A Prospective Trial

PM&R ◽  
2013 ◽  
Vol 5 ◽  
pp. S289-S290
Author(s):  
Naomi Lynn H. Gerber ◽  
Katee Armstrong ◽  
Jay P. Shah ◽  
Juliana Heimur ◽  
Paul Otto ◽  
...  
Keyword(s):  
Myofascial Pain ◽  
Prospective Trial ◽  
Trigger Points ◽  
Dry Needling ◽  
Myofascial Trigger Points

Poster 180 Dry-Needling Reduces Pain and Alters Status of Active Trigger Points in Subjects with Chronic Myofascial Pain: A Prospective Study

PM&R ◽  
2014 ◽  
Vol 6 (9) ◽  
pp. S248
Author(s):  
Naomi Lynn H. Gerber ◽  
Katee Armstrong ◽  
Paul R. Otto ◽  
Diego Turo ◽  
Tadesse M. Gebreab ◽  
...  
Keyword(s):  
Prospective Study ◽  
Myofascial Pain ◽  
Trigger Points ◽  
Dry Needling ◽  
A Prospective Study

scholarly journals Ultrasound-Guided Trigger Point Injections in the Cervicothoracic Musculature: A New and Unreported Technique

2008 ◽  
Vol 6;11 (12;6) ◽  
pp. 885-889 ◽  
Author(s):  
Kenneth P. Botwin
Keyword(s):  
Ultrasound Guidance ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Trigger Points ◽  
Target Tissue ◽  
Obese Patients ◽  
Needle Placement ◽  
Ultrasound Guided ◽  
Myofascial Trigger Points ◽  
Point Injection

Background: Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under diagnosed and under treated medical problems encountered in clinical practice. Trigger points are commonly seen in patients with myofascial pain which is responsible for localized pain in the affected muscles as well as referred pain patterns. Correct needle placement in a myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point injection to help reduce or relieve myofascial pain. In obese patients, these injections may not reach the target tissue. In the cervicothoracic spine, a misguided or misplaced injection can result in a pneumothorax. Here, we describe an ultrasound-guided trigger point injection technique to avoid this potential pitfall. Office based ultrasound-guided injection techniques for musculoskeletal disorders have been described in the literature with regard to tendon, bursa, cystic, and joint pathologies. For the interventionalist, utilizing ultrasound yields multiple advantages technically and practically, including observation of needle placement in real-time, ability to perform dynamic studies, the possibility of diagnosing musculoskeletal pathologies, avoidance of radiation exposure, reduced overall cost, and portability of equipment within the office setting. To our knowledge, the use of ultrasound guidance in performing trigger point injection in the cervicothoracic area, particularly in obese patients, has not been previously reported. Methods: A palpable trigger point in the cervicothoracic musculature was localized and marked by indenting the skin with the tip of a plastic needle cover. The skin was then sterile prepped. Then, using an ultrasound machine with sterile coupling gel and a sterile latex free transducer cover, the musculature in the cervicothoracic spine where the palpable trigger point was detected was visualized. Then utilizing direct live ultrasound guidance, a 25-gauge 1.5 inch needle connected to a 3 mL syringe was placed into the muscle at the exact location of the presumed trigger point. This guidance helps confirm needle placement in muscle tissue and not in an adipose tissue or any other non-musculature structure. Results: The technique is simple to be performed by a pain management specialist who has ultrasound system training. Conclusion: Ultrasound-guided trigger point injections may help confirm proper needle placement within the cervicothoracic musculature. The use of ultrasound-guided trigger point injections in the cervicothoracic musculature may also reduce the potential for a pneumothorax by an improperly placed injection. Key words: Trigger point injection, myofascial pain, ultrasound

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