砷化镓低能量激光治疗肌筋膜疼痛综合征73例

目的观察低能量激光对肌筋膜疼痛综合征的治疗效果。方法 73例肌筋膜疼痛综合征患者自身对照 ,采用波长830nm ,输出功率 5 0 0mW砷化镓半导体激光仪辐射治疗扳机点 2 0分钟 ,每日 1次 ,共 5次 ,在治疗前后分别进行疼痛自测、扳机点触压评定。结果治疗结束后 ,患者疼痛强度自测评分从 ( 7 2 4± 2 4)降至 ( 2 2 1± 1 2 2 ) (P <0 0 0 1) ,扳机点压痛显著改善。结论半导体激光治疗能降低疼痛强度 ,减轻压痛     

实时剪切波弹性成像对颈肩部肌筋膜疼痛综合征阿是穴针刺疗效评估

目的 探讨实时剪切波弹性成像（SWE）对颈肩部肌筋膜疼痛综合征（MPS）患者经阿是穴针刺治疗后的效果评估价值。方法 应用SWE技术定量测量30例颈肩部肌筋膜疼痛综合征（MPS）患者经阿是穴针刺治疗前后斜方肌疼痛触发点的弹性模量值及弹性评分,并且测量患者治疗前后的疼痛视觉模拟评分（VAS）。结果 针刺治疗前患者VAS评分与斜方肌MTrPs杨氏模量值及弹性评分均呈明显正相关(r=0.572, P<0.001;r=0.474, P=0.008),经阿是穴针刺治疗后,MPS患者VAS评分较治疗前减低(t=10.02, P<0.001),斜方肌MTrPs超声弹性成像评分 (t=6.34, P<0.001)及杨氏模量值(t=33.36,P<0.001)明显降低,差异均具有统计学意义;经针刺治疗后?VAS、?杨氏模量值与?弹性评分均呈明显正相关(r=0.611, P<0.001;r=0.561, P=0.001)。 结论 实时剪切波弹性成像能客观有效评估颈肩部肌筋膜膜疼痛综合征阿是穴针刺疗效。     

Shock waves as treatment of mouse myofascial trigger points

Introduction

An abnormal increase in spontaneous neurotransmission can induce subsynaptic knots in the myocyte called myofascial trigger points. The treatment of choice is to destroy these trigger points by inserting needles. However, 10% of the population has a phobia of needles, blood, or injuries. Therefore, the objective of this study is to verify the usefulness of shock waves in the treatment of myofascial trigger points.

Methods

Two groups of mice have been developed for this: healthy muscles treated with shock waves; trigger points affected muscles artificially generated with neostigmine and subsequently treated with shock waves. Muscles were stained with methylene blue, PAS-Alcian Blue, and labeling the axons with fluorescein and the acetylcholine receptors with rhodamine. Using intracellular recording the frequency of miniature endplate potentials (mEPPs) was recorded and endplate noise was recorded with electromyography.

Results

No healthy muscles treated with shock waves showed injury. Twitch knots in mice previously treated with neostigmine disappeared after shock wave treatment. Several motor axonal branches were retracted. On the other hand, shock wave treatment reduces the frequency of mEPPs and the number of areas with endplate noise.

Discussion

Shock waves seem to be a suitable treatment for myofascial trigger points. In the present study, with a single session of shock waves, very relevant results have been obtained, both functional (normalization of spontaneous neurotransmission) and morphological (disappearance of myofascial trigger points). Patients with a phobia of needles, blood, or injuries who cannot benefit from dry needling may turn to noninvasive radial shock wave treatment.     

Are "cervicogenic" headaches due to myofascial pain and cervical spine dysfunction?

The purpose of this investigation was to evaluate whether the pain of cervicogenic headache could be due to referred symptoms from myofascial trigger points. The presence or absence of cervical spine dysfunction was also of interest. Eleven patients with cervicogenic headaches were systematically examined for myofascial trigger points and cervical spine dysfunction. All patients had at least three myofascial trigger points on the symptomatic side. In eight of these patients, trigger point palpation clearly reproduced their headache. There were 70 myofascial trigger points (35 "very tender", 35 "tender") and 17 non-myofascial tender points on the symptomatic side, compared to 22 myofascial trigger points (one "very tender", 21 "tender") and 19 non-myofascial tender points on the asymptomatic side. These differences were statistically significant [chi-square (2df) = 22.04, p less than 0.0001]. All patients had some evidence of cervical dysfunction. Ten patients (91%) had specific segmental dysfunction of occiput on atlas and/or atlas on axis. Five patients were entered into a non-invasive, interdisciplinary pain management program designed to treat cervical spine dysfunction and myofascial pain. Treated patients reported a significant decrease in the frequency and intensity of their headaches during a median two-year follow-up. It is concluded that myofascial trigger points may be an important pain producing mechanism in cervicogenic headache and that segmental cervical dysfunction is a common feature in such patients. Conservative, non-surgical treatment appears to be effective in reducing the frequency and intensity of cervicogenic headache. These data suggest that surgical approaches should be reserved only for those patients who fail conservative therapy.     

A Critical Appraisal of the Evidence for Botulinum Toxin Type A in the Treatment for Cervico‐Thoracic Myofascial Pain Syndrome

Myofascial pain syndrome (MPS) is a musculoskeletal condition characterized by regional pain and muscle tenderness associated with the presence of myofascial trigger points (MTrPs). The last decade has seen an exponential increase in the use of botulinum toxin (BTX) to treat MPS. To understand the medical evidence substantiating the role of therapeutic BTX injections and to provide useful information for the medical practitioner, we applied the principles of evidence‐based medicine to the treatment for cervico‐thoracic MPS. A search was conducted through MEDLINE (PubMed, OVID, MDConsult), EMBASE, SCOPUS and the Cochrane database for the period 1966 to 2012 using the following keywords: myofascial pain, muscle pain, botulinum toxin, trigger points, and injections. A total of 7 trials satisfied our inclusion criteria and were evaluated in this review. Although the majority of studies found negative results, our analysis identified Gobel et al.'s as the highest quality study among these prospectively randomized investigations. This was due to appropriate identification of diagnostic criteria, excellent study design and objective endpoints. The 6 other identified studies had significant failings due to deficiencies in 1 or more major criteria. We conclude that higher quality, rigorously standardized studies are needed to more appropriately investigate this promising treatment modality.     

New views of myofascial trigger points: etiology and diagnosis

Simons DG. New views of myofascial trigger points: etiology and diagnosis.Two studies appearing in Archives, one by Shah and colleagues and another one by Chen and colleagues, present groundbreaking findings that can reduce some of the controversy surrounding myofascial trigger points (MTPs). Both author groups recognize the ubiquity of this disease and the importance to patients of health care professionals becoming better acquainted with the cause and identification of MTPs. The integrated hypothesis is the most credible and most complete proposed etiology of MTPs. However, the feedback loop suggested in this hypothesis has a few weak links, and studies by Shah and colleagues in particular supply a solid link for one of them. The feedback loop connects the hypothesized energy crisis with the milieu changes responsible for noxious stimulation of local nociceptors that causes the local and referred pain of MTPs. Shah’s reports quantify the presence of not just 1 noxious stimulant but 11 of them with outstanding concentrations of immune system histochemicals. The results also strongly place a solid histochemical base under the important clinical distinction between active and latent MTPs. The study by Chen on the use of magnetic resonance elastography (MRE) imaging of the taut band of an MTP in an upper trapezius muscle may open a whole new chapter in the centuries-old search for a convincing demonstration of the cause of MTP symptoms. MRE is a modification of existing magnetic resonance imaging equipment, and it images stress produced by adjacent tissues with different degrees of tension. This report seems to present an MRE image of the taut band that shows the chevron signature of the increased tension of the taut band compared with surrounding tissues.     

Myofascial Pain Syndrome: An Overview

Over the last few decades, advances have been made in the understanding of myofascial pain syndromes (MPSs). In spite of its high prevalence in the society, it is not a commonly established diagnosis. MPS is said to be the great imitator. This article puts some light on the various clinical presentations of the syndrome, on the various tools to reach to a diagnosis for commencing the treatment and on the treatment modalities that have been used so far.     

Myofascial Pain Syndrome Affecting the Quadratus Femoris

The quadratus femoris is an external rotator of the hip. Quadratus femoris injury can accompany damage to the surrounding muscles. Guided by the clinical symptoms, the injection technique described here can facilitate accurate diagnosis in selected cases.     

The Short-Term Effects of Acupuncture on Myofascial Pain Patients After Clenching

Aim: Short‐term pain reduction from acupuncture in chronic myofascial pain subjects was evaluated using an 11‐point (0 to 10) numeric rating scale, visual analog scale (VAS), and pain rating of mechanical pressure on the masseter muscle. Methods: A single‐blind, randomized, controlled, clinical trial with an independent observer was performed. Fifteen chronic myofascial pain subjects over the age of 18 were randomly assigned into groups: nine subjects received real acupuncture; six subjects received sham acupuncture. Each subject clenched his/her teeth for 2 minutes. Acupuncture or sham acupuncture was administered at the Hegu Large Intestine 4 acupoint. Sham acupuncture was conducted by lightly pricking the skin with a shortened, blunted acupuncture needle through a foam pad, without penetrating the skin. The foam pad visually conceals the needle's point of the entry, so that the subject cannot discern which technique is being used. The subjects rated their general pain on a numeric rating scale. A mechanical pain stimulus was applied with an algometer and the subject rated his/her pain on a VAS. Statistical analysis was performed using the repeated measures anova , paired t‐tests, and Fisher's exact test as appropriate. Results: There was a statistically significant difference in pain tolerance with acupuncture (P = 0.027). There was statistically significant reduction in face pain (P = 0.003), neck pain (P = 0.011), and headache (P = 0.015) with perception of real acupuncture. Conclusion: Pain tolerance in the masticatory muscles increased significantly more with acupuncture than sham acupuncture.     

肩部常见软组织压痛点的临床研究

目的: 明确肩部软组织损伤性疾病常见压痛点的分布规律及临床特征。方法:对54例主诉肩部疼痛的患者行仔细的局部压痛点指压检查及解剖定位,并进行视觉模拟评分（VAS）疼痛量化评分。结果: 按压痛的发生率,肩部软组织损伤的常见压痛点主要分布于上斜方肌、冈下肌、肩峰下、喙突、肱骨结节间沟、喙突与肱骨小结节间、肱骨小结节以及肩胛骨外侧缘等处,且以上斜方肌、冈下肌、喙突、肱骨小结节和肩峰下等处的压痛最明显。结论: 肩部压痛点分布广泛,以三角肌区前部和肩胛区的压痛点最多且压痛最明显。肩部软组织损伤以肌筋膜痛多见,其压痛多为1处;而冻结肩和肩袖损伤的压痛点则较多。临床诊治肩部软组织痛时,应考虑上述特点。     

颞肌筋膜瓣即刻修复上颌骨缺损的临床观察

目的通过对颞肌筋膜瓣即刻修复上颌骨缺损病例的回顾性分析,评价其效果。方法 2003年2月至2005年7月,9例患者因上颌骨肿瘤进行上颌骨部分切除,术后即刻采用颞肌筋膜瓣修复重建。观察颞肌筋膜瓣成活情况、术后语音以及吞咽功能的恢复状况。结果 8例组织瓣全部成活,1例组织瓣部分成活。患者语言、吞咽、咀嚼功能恢复基本满意。结论颞肌筋膜瓣修复上颌骨缺损安全可靠,是较为理想的方法。     

Are tender points associated with cervical radiculopathy?

OBJECTIVE: To determine if there is an association between cervical radiculopathy and tender spots in the neck and upper extremity on the side of radiculopathy. DESIGN: Prospective cross-sectional study. SETTING: Outpatient spine clinic within an academic institution. PARTICIPANTS: Convenience sample of 16 subjects with unilateral cervical radiculopathy. Twelve subjects had C7 radiculopathy and 4 had C6 or C8 radiculopathy. INTERVENTION: Bilateral pain-pressure threshold measurement (14 muscles) of the neck and upper extremity. MAIN OUTCOME MEASURE: Side-to-side difference in pain-pressure threshold. RESULTS: Differences in frequency of tender spots were found only in the deltoid and flexor carpi radialis. Overall, more tender spots were found on the side of radiculopathy (75 vs 34, P < .01). Among subjects with C7 radiculopathy, the number of tender spots in C7 innervated muscles was greater on the side of radiculopathy (23 vs 7, P < .02). In contrast, no significant difference in the number of tender spots between sides was found when only non-C7 innervated muscles (P > 0.1) were considered. CONCLUSIONS: Cervical radiculopathy was associated with increased tender spots on the side of radiculopathy, with predilection toward muscles innervated by the involved nerve root.     

灰阶超声联合剪切波弹性成像评估肌筋膜疼痛综合征患者肌筋膜疼痛触发点

目的 探讨灰阶超声联合剪切波弹性成像（SWE）技术评估肌筋膜疼痛综合征（MPS）患者肌筋膜疼痛触发点（MTrPs）处肌肉形态及组织学特性的价值。方法 以28例MPS患者（36个MTrPs）为病例组,33名健康志愿者（33个正常肌肉点）为对照组。由2名检查者分别测量病例组MTrPs （上斜方肌）厚度、剪切波传播速度（SWV）及杨氏模量值（E）,1名检查者测量对照组上述参数,1周后2组均重复测量。采用组内相关系数（ICC）评价2名检查者检测结果的一致性,以Pearson检验分析MPS患者疼痛视觉模拟量表（VAS）评分与上斜方肌厚度、SWV及E的相关性。结果 2名检查者重复测量一致性、时间一致性及检查者间一致性均好或优（ICC 0.73~0.98）。病例组MPS患者上斜方肌厚度、SWV及E均高于对照组,差异均有统计学意义（P均<0.05）。MPS患者VAS评分与上斜方肌厚度无相关性（r=0.016,P=0.945）,与SWV （r=0.709,P<0.001）、E （r=0.653,P=0.002）均呈正相关。结论 灰阶超声联合SWE可定量评估MPS患者MTrPs处肌肉形态及组织学特性。     

Myofascial trigger points in early life

OBJECTIVE: To determine whether latent myofascial trigger points (MTPs) can be identified in healthy infants and in healthy adult subjects. DESIGN: Blind comparison. SETTING: Ambulatory. PARTICIPANTS: A convenience sample of 60 healthy adults and 60 infants (age range, 0-12mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: An algometer was used to measure the pressure pain threshold (PPT) on 3 different sites, including a midpoint (assumed to be the MTP site) in the brachioradialis muscle. RESULTS: The mean PPT values at the MTP site were significantly lower than the other sites in the adult muscles. However, no significant differences in PPT values among these 3 sites were found in the infants. Taut bands were found in all the adult muscles but none in the infants. CONCLUSIONS: In the adult subjects, the midpoint of brachioradialis muscle was significantly more irritable than other sites and the midpoint was probably a latent MTP. However, in the infants younger than 1 year old, such a phenomenon could not be observed in this study. It is very likely that the latent MTPs might not exist in early life, but develop in later life.     

超声引导下针刺触发点治疗足底筋膜炎

目的 观察超声引导下针刺触发点治疗足底筋膜炎的临床效果。方法 选取48例足底筋膜炎患者，并随机分为2组，对单纯组（n=24）采用单纯非负重跖腱膜拉伸训练，联合组（n=24）采用超声引导下针刺触发点结合非负重跖腱膜拉伸训练；分别于治疗前（T₀）及治疗后1个月（T₁）、3个月（T₂）对患者进行"第1步"数字疼痛评分（NPRS）、美国矫形外科足踝协会踝-后足功能评分（AOFAS）以及36条目健康调查量表中生理（PCS）和心理（MCS）评分。结果 治疗前后2组NPRS、AOFAS、PCS和MCS评分总体差异均有统计学意义（P均<0.01），治疗后均较治疗前改善。联合组T₁和T₂的NPRS均低于单纯组（P均<0.01），T₁和T₂的AOFAS、PCS评分均高于单纯组（P均<0.05），而2组间T₁和T₂的MCS评分差异均无统计学意义（P均>0.05）。结论 超声引导下针刺触发点联合拉伸训练和单纯非负重跖腱膜拉伸训练对于足底筋膜炎均有效，前者缓解疼痛和改善足踝功能效果更佳。     

Amitriptyline reduces myofascial tenderness in patients with chronic tension-type headache

The tricyclic anti-depressant amitriptyline is widely used in the treatment of chronic tension-type headache. The aim of the present study was to investigate whether the analgesic effect is caused by a reduction of muscle pain or by a general reduction of pain sensitivity. Thirty-three non-depressed patients with chronic tension-type headache were treated with amitriptyline 75 mg/day and with the highly selective serotonin reuptake inhibitor citalopram 20 mg/day in a 32-week, double-blind, placebo-controlled, three-way crossover study. At the end of each treatment period, actual headache intensity and pericranial myofascial tenderness were recorded, pressure pain detection and tolerance thresholds were measured in the finger and in the temporal region and the electrical pain threshold was measured at the labial commissure. Amitriptyline reduced tenderness and headache intensity significantly more than placebo (P=0.01 and P=0.04, respectively). The reduction in tenderness could be ascribed solely to the group of patients who responded to amitriptyline treatment by at least 30% reduction in headache while tenderness was unchanged in non-responders. Amitriptyline did not affect pressure or electrical pain thresholds at any of the examined locations. Citalopram had no significant effect on any of the examined parameters. These findings indicate that amitriptyline elicits its analgesic effect in chronic myofascial pain by reducing the transmission of painful stimuli from myofascial tissues rather than by reducing overall pain sensitivity. We suggest that this effect is caused by a segmental reduction of central sensitization in combination with a peripheral anti-nociceptive action.