Immediate Effect of Dry Needling at Myofascial Trigger Point on Hand Spasticity in Chronic Post-stroke Patients: A Multicenter Randomized Controlled Trial

Background: Hand spasticity after stroke influences the rehabilitation of hand function. Immediate and effective relief of spasticity potentially creates conditions for later rehabilitation training, which has far-reaching significance in the smooth transition of patients to the recovery period.Objective: To evaluate the immediate effect of dry needling (DN) at myofascial trigger point on hand spasticity in stroke patients.Methods: This was a prospective, evaluator blind, multicenter, randomized controlled study. A total of 210 participants were randomly divided into DN group (DN, N = 70), sham dry needling group (SDN, N = 70), and control group (N = 70). Participants in the DN group were treated with DN at myofascial trigger point five times (30 min each time) every week for 4 weeks. Subjects in the SDN group were manipulated the same way as in the DN group, except that the acupuncture site was located in the area adjacent to the myofascial trigger point, which constituted a SDN. Routine rehabilitation treatment was performed for participants in the two groups and in the control group. The primary evaluation index was the immediate effect of hand spasticity relief. Secondary evaluation indicators included the cumulative effect of hand spasticity relief from baseline to week 4, and the changes in flexion angles of the wrist, thumb, and fingers 2–5 in the rest position before, immediately after, and 4 weeks after intervention.Results: The immediate effective rate of spasticity relief (thumb, fingers 2–5, and wrist) of patients with different degrees of spasticity in the DN group was higher than that in the control and SDN groups (thumb, χ2 = 55.833, P < 0.001; fingers 2–5, χ2 = 68.096, P < 0.001; wrist, χ2 = 49.180, P < 0.001) (P < 0.05). The effective rate of spasticity relief from baseline to 4 weeks in the DN group exceeded that in the control group and SDN groups (thumb, χ2 = 8.806, P = 0.012; fingers 2–5, χ2 = 8.087, P = 0.018; and wrist, χ2 = 8.653, P = 0.013) (P < 0.05). No difference in immediate and cumulative effect was found between the control group and SDN group. The change of joints flexion angles in resting position before and after each treatment in the DN group was higher than that in the control and SDN groups (P < 0.05), but it was not significantly different between the control group and SDN group. At 4 weeks, although the change in the DN group was higher than that in the control group and SDN group, this difference was not statistically significant (P > 0.05).Conclusion: Dry needling can relieve varying degrees of hand spasticity instantly in post-stroke.Trial Registration:www.chictr.org.cn, ChiCTR1900022379.

CLINICAL-NEURO-PHYSIOLOGICAL CHARACTERISTICS OF MYOFASCIAL PAIN SYNDROME IN A PATIENT WITH LEFT HEMYPLEGIA AFTER INTRACEREBRAL HEMORRHAGIC STROKE

Myofascial pain syndrome (MFPS) is one of the most common comorbid pathological processes that develops in skeletal muscle in patients with stroke, which is manifested by local seals and pain in various parts of the muscle. Despite the fact that the interest in MFPS arose in the last century, the intimate mechanisms of its development and course remain to be fully explored. It was found that the main manifestations of MFPS were the presence of miofascial trigger point in the area of palpation of the corresponding muscle with local pain and hypersensitivity within the palpated cord-segmentes, the characteristic pattern of reflected pain and reflected autonomic phenomenon, local convulsive response during transverse palpation. It is accompanied by muscle fatigue and significant muscle weakness without severe atrophy. Attention is drawn to the clear recurrence-reproducibility of pain, ie the so-called "recognizable" pain. All of the above symptoms constitute a general pattern of the disease, which has diagnostic value and is proposed for use as prognostic parameters with the obligatory use of the results of electromyographic examination. Diagnosis of active and latent MTP was performed on the basis of generally accepted l signs. The greatest discomfort for the patient is the presence of active MTP with characteristic spontaneously reproducing pain. Latent MTP is detected in up to 90% of cases among healthy people, and adverse factors only contribute to their transition to an active state with a characteristic symptom complex. The presence of an active myofascial trigger point with a characteristic spontaneously reproducing pain is the most painful manifestation. Latent MTP is also detected in most cases among healthy people, and unfavorable factors only contribute to their transition to an active state with a characteristic symptom complex. The study of the number of turns of the adhesive part of the potential in the zone of active ICC showed that there is a concentration of fibers in the zone of one motor units (MU). The average value of this indicator increases in the early stages of the process by 2 times. Even a small degree of desynchronization of the potentials of individual MU causes an increase in the number of rounds, which reflects the number of fibers involved in the generation of MC PMU. Absence of spontaneous muscle fibers (MF) activity, registration of end plate (EP) activity, PMU parameters such as amplitude decrease, shift of neurohistogram of potential distribution by duration towards smaller values or high percentage of polyphasicity, due to increase in number of turns, and also change their adhesive part, increase of MF density in zone MTP - they all determine changes in structural and functional parameters by muscle type. The work is devoted to the clinical, neuro-physiological characteristics of a patient with MFPS on the background of intracerebral hemorrhage and left hemyplegia based on the analysis of the neuro-functional organization of the motor units of the back muscles. Substantiated genesis and possible mechanism of development and formation of myofascial trigger point in such patients.

Convolutional Neural Network Optimization Algorithm-Based Magnetic Resonance Imaging in Analysis of Chronic Pain Caused by the Myofascial Trigger Point

This study was to explore the value of magnetic resonance imaging (MRI) technology processed by convolutional neural network (CNN) optimization algorithms in the clinical research of patients with chronic pain caused by myofascial trigger points (MTrPs). Firstly, referring to the traditional iterative algorithm, this study iterated the convolution network and data consistency layer as a whole for several times, which increased the fitting ability of the data consistency layer and network. When it was applied to magnetic resonance examination, it could be concluded that the effect of its reconstruction method was better than the traditional convolution neural network without the data consistency layer. The image edge was clear, and the restoration effect of details was better. 100 patients with chronic neck pain caused by MTrP were collected and divided into an ultrasound treatment group and a local anesthetic drug injection group, with 50 cases in each group. In addition, 50 healthy volunteers were selected. After clinical treatment, the results showed that, after 3 weeks of treatment, the visual analog score (VAS) and the pain rating index (PRI) of the injection group were 3.16 ± 1.14 points and 4.92 ± 1.26 points, respectively; the present pain intensity (PPI) score was 2.06 ± 0.85 points, and the number of pain days per month was 7.73 ± 1.15. After 1 month of treatment, the VSA and PRI of the injection group were 1.24 ± 0.89 and 1.31 ± 0.97, respectively; the PPI score was 1.34 ± 0.65, and the number of pain days per month was 5.34 ± 0.98. In addition, there were 38 cases reaching the level of clinical cure, accounting for 76%. Therefore, all indicators in the injection group were better than those in the ultrasound treatment group, and the differences were statistically significant ( P < 0.05 ). The results of MRI examination showed that compared with the healthy control group, patients with chronic pain caused by the myofascial trigger point had reduced axial kurtosis (AK), mean kurtosis (MK), and radial kurtosis (RK) in multiple brain areas such as the right parahippocampal gyrus and the right medial prefrontal cortex. In short, chronic pain caused by the trigger point of the myofascial membrane would affect the microstructure of the gray matter of the patient’s brain. In clinical treatment, the efficacy of local anesthetic injection was better than ultrasound therapy.

Hubungan Umur Dan Jenis Kelamin Terhadap Myofascial Trigger point Syndrome (MTPS) Pada Guru SMP Ar Rahman

A person's age and gender will be related to physical capacity to some extent. As a person ages, muscle strength, sensory and motor abilities will also decrease. Thus age will be related to the work of a person. In general, women only have physical strength 2/3 of the physical ability or muscle strength of men, but in certain cases women are more careful than men. To get high work power, it is necessary to try to divide the tasks between men and women according to their respective abilities, skill and limitations. MTPS complaints often occur in teacher workers related to age, resulting in complaints of muscle pain. This study aims to determine the relationship between Age and Gender with Myofascial Trigger Point Syndrome (MTPS) against teachers at Ar Rahman School Medan. This type of research uses an analytic design with a cross sectional design. The population and sample were 32 people. The results showed that there was a relationship between age (p value = <0.005) and there was no relationship between sex (p value = >0.05) with Myofascial Trigger Point Syndrome (MTPS). It is recommended for teachers to take advantage of the rest time to relax muscles in order to improve and improve physiological function.

Efektivitas Friction Massage Terhadap Mengurangi Nyeri Pada Kasus Myofascial Trigger Point Syndrome Otot Upper Trapezius

Background: Myofascial trigger point syndrome is a musculoskeletal disorder characterized by the presence of a trigger point in a sensitive area within the skeletal muscle band linkages, if pressure is applied to the area it will cause specific pain at a point that is pressed (tenderness). Myofascial trigger point syndrome is influenced both by mechanism and by positioning factors. Myofascial trigger point syndrome upper trapezius muscle radiates along the upper back and neck, behind the ears and at the temples. Methods: The research method used is in the form of a case study with 1 patient who was given physiotherapy intervention and evaluation 4 times. To overcome the problem of muscle pain in bilateral trapezius m.upper in this study, using manual physiotherapy intervention therapy in the form of friction massage. Result: The results obtained, there was a decrease in tenderness in the upper trapezius muscle VAS 5 during the first evaluation to VAS 2 at the fourth evaluation with an average VAS value pre and post after one month for four interventions, namely 1.72. The MDC value (95) is 0.196 and the MCID range is 0.88-1.7, and 1.46-2.28. Conclusion: Based on these results, it can be concluded that physiotherapy intervention with the manual method of therapy, friction massage is considered effective in reducing pain in patients with myofascial trigger point syndrome, upper trapezius muscle with visual analogues scale (VAS) parameters. Keyword : Myofascial Trigger Point Syndrome, Manual Therapy, Friction Massage

Flexor Digitorum Brevis Muscle Dry Needling Changes Surface and Plantar Pressures: A Pre-Post Study

Background: The effects of the dry needling technique and pain reduction have been demonstrated in numerous quality studies. However, the mechanical effects of dry needling are largely unknown. Methods: A total of 18 subjects with flexor digitorum brevis muscle myofascial trigger point were evaluated pre- and post-deep dry needling. We measured static footprint variables in a pre–post study. Main findings: We found differences in rearfoot maximum pressure (119.22–111.63 KPa; p = 0.025), midfoot maximum pressure (13.68–17.26 KPa; p = 0.077), midfoot medium pressure (4.75–6.24 KPa; p = 0.035) and forefoot surface (86.58–81.75 cm2; p = 0.020). All variables with significant differences decrease, with the exception of forefoot surface which showed an increase. Conclusions: After flexor digitorum brevis muscle dry needling, midfoot plantar pressures (maximum and medium) and forefoot surface were increased, and rearfoot maximum pressure was decreased.