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A Novel Application of Musculoskeletal Ultrasound Imaging
Published on: September 17, 2013
Understanding the vascular environment of myofascial trigger points using ultrasonic imaging and computational
Siddhartha Sikdar1, Robin Ortiz, Tadesse Gebreab
1Department of Electrical and Computer Engineering, George Mason University, Fairfax, VA 22030, USA. ssikdar@gmu.edu
Abstract:
Myofascial pain syndrome (MPS) is a common, yet poorly understood, acute and chronic pain condition. MPS is characterized by local and referred pain associated with hyperirritable nodules known as myofascial trigger points (MTrPs) that are stiff, localized spots of exquisite tenderness in a palpable taut band of skeletal muscle. Recently, our research group has developed new ultrasound imaging methods to visualize and characterize MTrPs and their surrounding soft tissue. The goal of this paper was to quantitatively analyze Doppler velocity waveforms in blood vessels in the neighborhood of MTrPs to characterize their vascular environment. A lumped parameter compartment model was then used to understand the physiological origin of the flow velocity waveforms. 16 patients with acute neck pain were recruited for the study and the blood vessels in the upper trapezius muscle in the neighborhood of palpable MTrPs were imaged using Doppler ultrasound. Preliminary findings show that symptomatic MTrPs have significantly higher peak systolic velocities and negative diastolic velocities compared to latent MTrPs and normal muscle sites. Using compartment modeling, we show that a constricted vascular bed and an enlarged vascular volume could explain the observed flow waveforms with retrograde diastolic flow.
Insights
Myofascial pain syndrome (MPS) involves trigger points causing pain. New ultrasound methods reveal symptomatic trigger points have altered blood flow, suggesting constricted vessels and larger volumes contribute to pain.
Area of Science:
- Biomedical Engineering
- Pain Medicine
- Musculoskeletal Imaging
Background:
- Myofascial pain syndrome (MPS) is a prevalent pain condition characterized by myofascial trigger points (MTrPs).
- Understanding the vascular environment of MTrPs is crucial for elucidating MPS pathophysiology.
- Novel ultrasound imaging techniques offer new insights into MTrP characteristics.
Purpose of the Study:
- To quantitatively analyze Doppler velocity waveforms in blood vessels near MTrPs.
- To characterize the vascular environment of symptomatic and latent MTrPs.
- To investigate the physiological origins of observed flow patterns using a compartment model.
Main Methods:
- Recruitment of 16 patients with acute neck pain.
- Doppler ultrasound imaging of blood vessels in the upper trapezius muscle near MTrPs.
- Application of a lumped parameter compartment model to analyze flow velocity waveforms.
Main Results:
- Symptomatic MTrPs exhibited significantly higher peak systolic velocities compared to latent MTrPs and normal muscle.
- Negative diastolic velocities were observed in symptomatic MTrPs.
- Compartment modeling indicated a constricted vascular bed and enlarged vascular volume could explain the flow patterns.
Conclusions:
- Symptomatic MTrPs demonstrate distinct vascular Doppler velocity waveform characteristics.
- The observed retrograde diastolic flow may be attributed to vascular constriction and volume changes.
- This study provides quantitative vascular insights into myofascial pain syndrome.
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