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

我们的研究结果证实，与无肌筋膜触发点或潜伏期(无症状)肌筋膜触发点的受试者相比，有活跃肌筋膜触发点的受试者在局部肌筋膜触发点的局部环境中具有显著不同的生化特征(即促炎介质、神经肽、细胞因子和儿茶酚胺水平升高)。众所周知，这些物质与慢性疼痛状态有关。此外，我们发现活动组的斜方肌和未受影响的腓肠肌在针头插入时的分析物水平存在显著差异，这表明活动的MTrP附近显示出与疼痛和炎症相关的物质的独特生化环境。此外，活动组的腓肠肌分析物水平高于潜伏组或正常组。这进一步表明，分析物异常可能不仅限于上斜方肌活跃的MTrP的局部区域，而且也可能存在于远离活跃的MTrP的位置。 MTrP是骨骼肌束中一个明显的、谨慎的、局部的压痛点。尽管MTrp的发病率很高，但目前还没有诊断MTrp或评估治疗临床结果的影像标准。因此，肌筋膜痛的诊断完全基于病史和体格检查。 我们使用诊断超声成像和振动超声弹性成像的初步发现表明，根据组织僵硬和局部肌肉血流特性的回声测量的不同，MTrP可以与周围肌肉区分开来。 目前尚不清楚MTrp和未受累肌肉的症状和体征随着时间的推移是如何表现的；它们可能会改善、恶化或保持稳定。我们怀疑MTrp的症状和物理表现会随着时间的推移而改变，我们打算将任何临床变化与局部生化分析物水平、MTrp的粘弹性特性以及未受影响的组织和局部肌肉的血流特性相关联。

Our findings confirm that subjects with active myofascial trigger points (MTrPs) have a significantly different biochemical profile (i.e., elevated levels of pro-inflammatory mediators, neuropeptides, cytokines, and catecholamines) within the local milieu of the MTrP compared to those without MTrPs or those with a latent (non-symptomatic) MTrP. These classes of substances are known to be associated with chronic pain states. Furthermore, we found significant differences in analyte levels at needle insertion between the trapezius and unaffected gastrocnemius in the Active group, suggesting that the vicinity of the active MTrP exhibits a unique biochemical milieu of substances associated with pain and inflammation. Additionally, gastrocnemius analyte levels were higher in the Active group than either the Latent or Normal groups. This further suggests that analyte abnormalities may not be limited to local areas of active MTrPs in the upper trapezius but may also be present at sites remote from the active MTrP. The MTrP is a palpable, discreet, localized tender spot in a taut band of skeletal muscle. In spite of the high prevalence, there are currently no imaging criteria for the diagnosis of MTrPs or for assessing clinical outcome of treatments. Accordingly, the diagnosis of myofascial pain is based exclusively on history and physical examination. Our preliminary findings using diagnostic ultrasound imaging and vibration sonoelastography suggest that MTrPs can be differentiated from surrounding muscle based on differences in echogenicity measures of tissue stiffness and local muscle blood flow properties. It is unclear how the symptoms and physical findings of MTrPs and uninvolved muscle behave over time; they could improve, worsen or remain stable. It is suspected that the symptoms and physical findings of MTrPs will change over time, and we intend to correlate any clinical changes with local biochemical analyte levels, viscoelastic properties of the MTrP and unaffected tissue and local muscle blood flow properties.