Department of Anesthesiology, Clement Zablocki VA Medical Center & Medical College of Wisconsin, Milwaukee, WI, USA.
Pain Med. 2012 Jul;13(7):971-5. doi: 10.1111/j.1526-4637.2012.01411.x. Epub 2012 Jun 8.
Ultrasound imaging has gained acceptance in pain management interventions. Features of myofascial pain syndrome have been explored using ultrasound imaging and elastography. There is a paucity of reports showing the benefit clinically. This report provides three-dimensional features of taut bands and highlights the advantages of using two-dimensional ultrasound imaging to improve targeting of taut bands in deeper locations.
Fifty-eight-year-old man with pain and decreased range of motion of the right shoulder was referred for further management of pain above the scapula after having failed conservative management for myofascial pain syndrome. Three-dimensional ultrasound images provided evidence of aberrancy in the architecture of the muscle fascicles around the taut bands compared to the adjacent normal muscle tissue during serial sectioning of the accrued image. On two-dimensional ultrasound imaging over the palpated taut band, areas of hyperechogenicity were visualized in the trapezius and supraspinatus muscles. Subsequently, the patient received ultrasound-guided real-time lidocaine injections to the trigger points with successful resolution of symptoms.
This is a successful demonstration of utility of ultrasound imaging of taut bands in the management of myofascial pain syndrome. Utility of this imaging modality in myofascial pain syndrome requires further clinical validation.
超声成象在疼痛管理干预中已得到认可。肌筋膜疼痛综合征的特征已通过超声成象和弹性成像进行了探索。尽管有一些报告显示了其临床益处，但缺乏相关报道。本报告提供了紧张带的三维特征，并强调了使用二维超声成像来改善对深部紧张带的靶向治疗的优势。
一名 58 岁男性，右肩疼痛且活动范围减小，经肌筋膜疼痛综合征的保守治疗失败后，因肩胛上方疼痛而被转介进一步治疗。在对累积图像进行连续切片时，三维超声图像显示紧张带周围的肌肉纤维束结构异常，与相邻正常肌肉组织相比。在触诊到的紧张带上进行二维超声成像时，斜方肌和冈上肌可见到高回声区域。随后，对触发点进行了超声引导实时利多卡因注射，症状得到成功缓解。
这成功地展示了超声成像在肌筋膜疼痛综合征管理中的紧张带的应用。这种成像方式在肌筋膜疼痛综合征中的应用需要进一步的临床验证。
