Elbarbary Mohamed, Goldberg Michael, Tenenbaum Howard C, Lam David K, Freeman Bruce V, Pustaka David J, Mock David, Beyene Joseph, Azarpazhooh Amir
Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada; Advanced Training Program in Orofacial Pain, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada; Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
J Endod. 2023 Feb;49(2):129-136. doi: 10.1016/j.joen.2022.11.013. Epub 2022 Nov 29.
Masticatory myofascial pain is a musculoligamentous syndrome that can mimic odontogenic pain. Pain referral to odontogenic structures can be traced to hyperirritated myofascial trigger points (MTrPs). This pragmatic study evaluated the concordance between ultrasonography and palpation in detecting MTrPs in the masseter and temporalis muscles.
Fifty-seven patients suspected to have temporomandibular disorder were included. MTrPs were palpated manually by expert clinicians. Ultrasonography was then performed by a blind sonographer. The quantity of MTrPs and the involved muscle sections, the pain occurrence, and the location of the MTrPs within the muscle sections were compared using the mean difference (MD) and concordance statistics (Cohen κ and the interclass correlation coefficient [ICC]) as applicable.
Ultrasonography located MTrPs as 2.1 ± 1.3 mm hypoechoic nodules at a depth of 7 ± 3.3 mm. Ultrasonography moderately agreed with palpation on the quantity of MTrPs per patient (MD = 1; 95% confidence interval [CI], 0.06-1.9; ICC = 0.56; 95% CI, 0.32-0.72). Palpation detected marginally more involved muscle sections per patient (MD = 0.7; 95% CI, 0.06-1.34.05; ICC = 0.64; 95% CI, 0.44-0.77) with more pain occurrence per patient (MD = 1.4; 95% CI, 0.56-2.28; ICC = 0.13; 95% CI, -0.26 to 0.41). There was a discordance in the location of the MTrPs within the muscle sections per patient (κ = -0.46; 95% CI, -0.77 to -0.14).
Ultrasonography and palpation concurred moderately to substantially on the quantity of MTrPs and the involved muscle sections but disagreed on the location of the MTrPs within the muscle sections. Ultrasonography has the potential as a chairside diagnostic aid to help clinicians determine an accurate diagnosis, enhance patient experience during examination, and avoid unnecessary treatments that can mitigate the risk of iatrogenic damage.
咀嚼肌筋膜疼痛是一种肌肉韧带综合征，可模拟牙源性疼痛。牙源性结构的疼痛牵涉可追溯到超敏的肌筋膜触发点（MTrP）。本实用研究评估了超声检查与触诊在检测咬肌和颞肌MTrP方面的一致性。
纳入57例疑似颞下颌关节紊乱的患者。由专业临床医生手动触诊MTrP。然后由一名不知情的超声检查人员进行超声检查。使用平均差（MD）和一致性统计量（Cohen κ系数和组内相关系数[ICC]）（如适用）比较MTrP的数量、受累肌肉节段、疼痛发生情况以及MTrP在肌肉节段内的位置。
超声检查发现MTrP为深度7±3.3mm处的2.1±1.3mm低回声结节。超声检查与触诊在每位患者的MTrP数量上中度一致（MD = 1；95%置信区间[CI]，0.06 - 1.9；ICC = 0.56；95% CI，0.32 - 0.72）。触诊发现每位患者受累肌肉节段略多（MD = 0.7；95% CI，0.06 - 1.34.05；ICC = 0.64；95% CI，0.44 - 0.77），每位患者疼痛发生情况更多（MD = 1.4；95% CI，0.56 - 2.28；ICC = 0.13；95% CI， - 0.26至0.41）。每位患者的MTrP在肌肉节段内的位置存在不一致（κ = - 0.46；95% CI， - 0.77至 - 0.14）。
超声检查与触诊在MTrP数量和受累肌肉节段方面中度至高度一致，但在MTrP在肌肉节段内的位置上存在不一致。超声检查有潜力作为一种床边诊断辅助手段，帮助临床医生进行准确诊断，提升检查期间的患者体验，并避免可能减轻医源性损伤风险的不必要治疗。
