Comparison of the Local Tissue Milieu in Normal muscle and Active and Latent Myo

正常肌肉与活跃和潜在肌肉局部组织环境的比较

• 批准号: 8565363
• 负责人: Jay Shah
• 金额: --
• 依托单位: CLINICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8565363
• 关键词: Address; Affect; Aftercare; Area; Biochemical; Biomechanics; Blood Vessels; Blood flow; Characteristics; Chronic neck pain; Clinical; Data; Diagnosis; Environment; Equipment; Etiology; Functional disorder; Goals; Gold; Heterogeneity; Image; Imaging Techniques; Inflammation; Lead; Measurable; Measurement; Measures; Mechanics; Methods; Monitor; Muscle; Myalgia; Myofascial Pain Syndromes; Myofascial Trigger Point; Natural History; Neck Pain; Needles; Nodule; Normal tissue morphology; Outcome Measure; Outpatients; Pain; Pain Disorder; Pain management; Palpable; Palpation; Patients; Physical Examination; Physiology; Property; Recording of previous events; Research; Secondary to; Site; Skeletal Muscle; Speed; System; Techniques; Time; Tissues; Translating; Treatment Efficacy; Ultrasonography; active method; base; chronic pain; clinical care; diagnosis standard; digital; indexing; medical specialties; novel; physical property; soft tissue; trapezius muscle; trigger point; vibration

Myofascial pain syndrome (MPS) is a condition associated with regional pain and muscle tenderness characterized by the presence of hypersensitive nodules, also called myofascial trigger points (MTrPs). MPS affects up to 95% of people with chronic pain disorders and is a common finding in patients in specialty pain management centers. However, the etiology of myofascial pain and the pathophysiology of MTrPs are unclear. MTrPs are palpable, stiff nodules in a taut band of skeletal muscle - a characteristic finding in MPS. Although digital palpation is considered the gold standard for diagnosis of MPS, it does not 1) provide an objective, reliable and sensitive method of diagnosis and measurement of treatment efficacy; 2) provide quantitative comparisons of the tissue properties before and after treatment; 3) objectively differentiate among active MTrPs, latent MTrPs, and palpably normal tissue; 4) objectively discriminate between superficial and deep MTrPs; and 5) permit objective study of the natural history of MTrPs. To address these limitations, our team is utilizing novel applications of diagnostic ultrasound imaging techniques, such as grayscale (2D Ultrasound), vibration sonoelastography, and Doppler, to image the MTrP and its surrounding muscle as well as the local microvasculature and blood flow properties of muscle harboring MTrPs. Through the use of these techniques, our team sought to better understand the physical properties and vascular environment of active MTrPs, latent MTrPs, and palpably normal tissue. Our objectives also included developing new, efficient, and easy to administer elastography techniques to provide quantitative characterization of viscoelastic properties of skeletal muscle in an outpatient clinical environment using off-the-shelf office-based equipment. The sonoelastography studies showed that active MTrPs had larger areas compared to latent MTrPs and palpably normal tissue and therefore MTrPs may be classified by area. Doppler spectral waveform data indicated that blood vessels near these active MTrP sites had a significantly higher pulsatility index compared to normal sites, a finding that may be useful in evaluating the history of MPS. Vibration sonoelastography demonstrated that MTrPs in upper trapezius had significantly higher shear modulus (measure of rigidity) and active MTrPs had significantly higher shear wave speeds (related to viscoelastic properties) when compared to palpably normal tissue. These results indicate that MTrPs and their surrounding tissue have increased tissue heterogeneity. Our research has yielded a better understanding of the pathophysiology of myofascial pain and has implications for clinical care. The sonoelastography techniques can be easily translated to the clinical setting using off the shelf office-based equipment to quantitatively characterize biomechanical properties of skeletal muscle. Furthermore, it can overcome the subjectivity of palpation and physical examination, and could lead to an objective clinical outcome measure. We believe that longitudinal monitoring of biomechanical properties of both MTrPs and the surrounding muscle tissue over time and before and after treatment can provide a better mechanistic understanding of the changes that occur in the environment of the upper trapezius following treatment for active MTrPs, such as dry needling therapy.

肌筋膜疼痛综合征（MPS）是一种与局部疼痛和肌肉压痛相关的疾病，其特征在于存在过敏性结节，也称为肌筋膜触发点（MTrP）。MPS影响高达95%的慢性疼痛障碍患者，是专业疼痛管理中心患者的常见发现。然而，肌筋膜疼痛的病因和肌筋膜痛的病理生理学尚不清楚。 MTrPs是骨骼肌绷紧带中可触及的坚硬结节-MPS的特征性发现。虽然手指触诊被认为是诊断MPS的金标准，但它不能：1）提供客观、可靠和敏感的诊断和治疗疗效测量方法; 2）提供治疗前后组织特性的定量比较; 3）客观区分活动性MTrPs、潜伏性MTrPs和可触及的正常组织; 4）客观区分浅表和深部MTrPs;和5）允许对MTRP的自然历史进行客观研究。 为了解决这些局限性，我们的团队正在利用诊断超声成像技术的新应用，如灰度（2D超声），振动声弹性成像和多普勒，以成像MTrP及其周围肌肉以及局部微血管和肌肉的血流特性。通过使用这些技术，我们的团队试图更好地了解活跃的MTrPs，潜伏的MTrPs和可触及的正常组织的物理特性和血管环境。我们的目标还包括开发新的，有效的，易于管理的弹性成像技术，提供定量表征的粘弹性的骨骼肌在门诊临床环境中使用现成的办公室为基础的设备。 超声弹性成像研究表明，与潜伏性MTrPs和可触及的正常组织相比，活动性MTrPs具有更大的面积，因此MTrPs可按面积分类。多普勒频谱波形数据表明，与正常部位相比，这些活动性MTrP部位附近的血管具有显著更高的脉动指数，这一发现可能有助于评估MPS病史。振动超声弹性成像表明，MTrPs在上腭肌有显着更高的剪切模量（刚度的措施）和积极的MTrPs有显着更高的剪切波速度（粘弹性）相比，可触知的正常组织。这些结果表明，MTRP及其周围组织具有增加的组织异质性。 我们的研究对肌筋膜疼痛的病理生理学有了更好的理解，并对临床护理有一定的意义。超声弹性成像技术可以很容易地转化为临床设置使用现成的办公室为基础的设备，定量表征骨骼肌的生物力学性能。此外，它可以克服触诊和体格检查的主观性，并可能导致客观的临床结果测量。我们认为，随着时间的推移和治疗前后的MTRP和周围肌肉组织的生物力学特性的纵向监测可以提供一个更好的机制的理解，发生在环境中的变化，在积极的MTRP治疗，如干针疗法后，上肌。

项目成果

Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue.

• DOI: 10.1016/j.apmr.2009.04.015
• 发表时间: 2009-11
• 期刊: ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
• 影响因子: 4.3
• 作者: Sikdar, Siddhartha;Shah, Jay P.;Gebreab, Tadesse;Yen, Ru-Huey;Gilliams, Elizabeth;Danoff, Jerome;Gerber, Lynn H.
• 通讯作者: Gerber, Lynn H.