Ann Rehabil Med.  2014 Oct;38(5):673-681. 10.5535/arm.2014.38.5.673.

Ultrasound-Guided Myofascial Trigger Point Injection Into Brachialis Muscle for Rotator Cuff Disease Patients With Upper Arm Pain: A Pilot Study

• Suh MR
• Chang WH
• Choi HS
• Lee SC

• KMID: 2266502
• DOI: http://doi.org/10.5535/arm.2014.38.5.673

Abstract

OBJECTIVE
To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper arm pain.
METHODS
A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS).
RESULTS
US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (capital DE, CyrillicVAS=-2.8) was significantly larger than caused by oral NSAID (capital DE, CyrillicVAS=-1.5) (p<0.05).
CONCLUSION
In patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of pain is suspected to be originated from the muscle.

Keyword

Myofascial pain syndromes; Shoulder pain; Rotator cuff; Ultrasonography

MeSH Terms

Arm*
Diagnosis
Humans
Myofascial Pain Syndromes
Pilot Projects*
Prospective Studies
Rehabilitation
Rotator Cuff*
Shoulder Pain
Trigger Points*
Ultrasonography
Visual Analog Scale

Figure

• 

  Fig. 1 Design of the study. MR, magnetic resonance; NSAID, non-steroidal anti-inflammatory drug.

• 

  Fig. 2 Proper positioning during injection procedure. (A) The patient is laid on the lateral side with the affected side up, with the upper arm placed tightly to the trunk to minimize the motion during injection. (B) The probe is positioned on the maximal tender point to show the transverse image of the brachialis muscle, and the needle is approached with inplane method.

• 

  Fig. 3 Transverse ultrasound image of the brachialis muscle. The brachialis muscle (Br) is seen below the biceps brachii muscle (Bi). H, humerus; T, triceps.

• 

  Fig. 4 Transverse ultrasound image by the in-plane method. Needle passage into the target muscle (Br) is visualized (arrow). Bi, biceps brachii; Br, brachialis; H, humerus.

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  Fig. 5 Effect of each treatment. VAS changes significantly after injection and medication (*p<0.05) and VAS in injection group decreases more compared to the medication group after treatment (†p<0.05). VAS, visual analogue scale; pre-VAS, VAS at pretreatment; post-VAS, VAS after 2 weeks of treatment.

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