Rozenfeld E, Finestone A S, Moran U, Damri E, Kalichman L
Israel Defense Force, Medical Corps, Israel; Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Assaf HaRofeh Medical Center, Zeriffin, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
J Bodyw Mov Ther. 2017 Oct;21(4):914-919. doi: 10.1016/j.jbmt.2017.03.023. Epub 2017 Mar 29.
Myofascial trigger points (MTrP's) are a primary source of pain in patients with musculoskeletal disorders. Nevertheless, they are frequently underdiagnosed. Reliable MTrP palpation is the necessary for their diagnosis and treatment. The few studies that have looked for intra-tester reliability of MTrPs detection in upper body, provide preliminary evidence that MTrP palpation is reliable. Reliability tests for MTrP palpation on the lower limb have not yet been performed.
To evaluate inter- and intra-tester reliability of MTrP recognition in hip and thigh muscles.
Reliability study.
21 patients (15 males and 6 females, mean age 21.1 years) referred to the physical therapy clinic, 10 with knee or hip pain and 11 with pain in an upper limb, low back, shin or ankle.
Two experienced physical therapists performed the examinations, blinded to the subjects' identity, medical condition and results of the previous MTrP evaluation. Each subject was evaluated four times, twice by each examiner in a random order. Dichotomous findings included a palpable taut band, tenderness, referred pain, and relevance of referred pain to patient's complaint. Based on these, diagnosis of latent MTrP's or active MTrP's was established. The evaluation was performed on both legs and included a total of 16 locations in the following muscles: rectus femoris (proximal), vastus medialis (middle and distal), vastus lateralis (middle and distal) and gluteus medius (anterior, posterior and distal).
Inter- and intra-tester reliability (Cohen's kappa (κ)) values for single sites ranged from -0.25 to 0.77. Median intra-tester reliability was 0.45 and 0.46 for latent and active MTrP's, and median inter-tester reliability was 0.51 and 0.64 for latent and active MTrPs, respectively. The examination of the distal vastus medialis was most reliable for latent and active MTrP's (intra-tester k = 0.27-0.77, inter-tester k = 0.77 and intra-tester k = 0.53-0.72, inter-tester k = 0.72, correspondingly).
Inter- and intra-tester reliability of active and latent MTrP evaluation was moderate to substantial. Palpation evaluation can be used for clinical diagnosis of MTrP's in the hip and thigh muscles.
This study provides evidence that MTrP palpation is a moderately reliable diagnostic tool in the hip and thigh muscles and can be used in clinical practice and research.
肌筋膜触发点（MTrP）是肌肉骨骼疾病患者疼痛的主要来源。然而，它们经常被漏诊。可靠的MTrP触诊是其诊断和治疗的必要条件。少数针对上半身MTrP检测的测试者内可靠性研究提供了初步证据，表明MTrP触诊是可靠的。尚未对下肢MTrP触诊进行可靠性测试。
评估测试者间和测试者内对髋部和大腿肌肉中MTrP识别的可靠性。
可靠性研究。
21名转诊至物理治疗诊所的患者（15名男性和6名女性，平均年龄21.1岁），其中10名有膝盖或髋部疼痛，11名有上肢、下背部、小腿或脚踝疼痛。
两名经验丰富的物理治疗师进行检查，对受试者的身份、病情和先前MTrP评估结果不知情。每位受试者接受四次评估，每位检查者各进行两次，顺序随机。二分法结果包括可触及的紧张带、压痛、牵涉痛以及牵涉痛与患者主诉的相关性。基于这些结果，确定潜在MTrP或活跃MTrP的诊断。对双腿进行评估，包括以下肌肉中的总共16个部位：股直肌（近端）、股内侧肌（中部和远端）、股外侧肌（中部和远端）和臀中肌（前部、后部和远端）。
单个部位的测试者间和测试者内可靠性（Cohen's kappa（κ））值范围为-0.25至0.77。潜在和活跃MTrP的测试者内可靠性中位数分别为0.45和0.46，潜在和活跃MTrP的测试者间可靠性中位数分别为0.51和0.64。股内侧肌远端的检查对于潜在和活跃MTrP最为可靠（测试者内κ = 0.27 - 0.77，测试者间κ = 0.77；测试者内κ = 0.53 - 0.72，测试者间κ = 0.72）。
活跃和潜在MTrP评估的测试者间和测试者内可靠性为中度至高度。触诊评估可用于髋部和大腿肌肉中MTrP的临床诊断。
本研究提供了证据，表明MTrP触诊在髋部和大腿肌肉中是一种中度可靠的诊断工具，可用于临床实践和研究。
