J Yeungnam Med Sci.  2024 Jul;41(3):179-187. 10.12701/jyms.2024.00416.

Ultrasound imaging and guidance in the management of myofascial pain syndrome: a narrative review

• Wu WT
• Chang KV
• Ricci V
• Özçakar L

• KMID: 2558142
• DOI: http://doi.org/10.12701/jyms.2024.00416

Abstract

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder characterized by muscle pain, tenderness, and trigger points. Ultrasonography has emerged as a key tool for diagnosing and treating MPS owing to its ability to provide precise, minimally invasive guidance. This review discusses the use of ultrasonography in various approaches to evaluate and manage MPS. Studies have shown that shear-wave sonoelastography can effectively assess muscle elasticity and offer insights into trapezius stiffness in patients with MPS. Ultrasound-guided interfascial hydrodissection, especially with visual feedback, has demonstrated effectiveness in treating trapezius MPS. Similarly, ultrasound-guided rhomboid interfascial plane blocks and perimysium dissection for posterior shoulder MPS have significantly reduced pain and improved quality of life. The combination of extracorporeal shockwave therapy with ultrasound-guided lidocaine injections has been particularly successful in reducing pain and stiffness in trapezius MPS. Research regarding various guided injections, including dry needling, interfascial plane blocks, and fascial hydrodissection, emphasizes the importance of ultrasonography for accuracy and safety. Additionally, ultrasound-guided delivery of local anesthetics and steroids to the quadratus lumborum muscle has shown lasting pain relief over a 6-month period. Overall, these findings highlight the pivotal role of ultrasonography in the assessment and treatment of MPS.

Keyword

Injections; Muscles; Sonography; Trigger points; Ultrasonography

Figure

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  Fig. 1. Illustration of (A) color map and (B) propagation mode demonstrating the measurement of shear-wave velocity in the trapezius muscle.

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  Fig. 2. Ultrasound imaging (left side) and schematic drawing (right side) of ultrasound-guided interfascial hydrodissection of the trapezius muscle: (A) before and (B) after administering the injectant. The arrowheads indicate the needle trajectory, while the asterisk marks the injectant. The arrows represent the needle trajectory.

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  Fig. 3. (A) Ultrasound imaging and (B) schematic drawing of ultrasound-guided rhomboid interfascial plane block. The arrowheads indicate the needle trajectory, while the asterisks mark the injectant. The arrow represents the needle trajectory.

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  Fig. 4. (A) Ultrasound imaging and (B) schematic drawing of ultrasound-guided perimysium dissection of the infraspinatus muscle. The black arrowheads indicate the needle trajectory, while the white arrowheads mark the perimysium. The arrow represents the needle trajectory.

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  Fig. 5. Ultrasound imaging (left side) and schematic drawing (right side) of ultrasound-guided procedures: (A) myofascial trigger point injection and (B) fascial hydrodissection. The black arrowheads point to the needle trajectory, while the white arrowheads indicate the superficial fascia in the subcutaneous tissue. The arrows represent the needle trajectory, whereas the dash lines indicate the fascia.

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  Fig. 6. (A) Ultrasound imaging and (B) schematic drawing of ultrasound-guided local anesthetic and steroid injection of the quadratus lumborum (QL) muscle. IC, iliac crest. The arrowheads point to the needle trajectory. The arrow represents the needle trajectory.

Reference

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