B-mode ultrasound characterization of myofascial trigger points and their response to physiotherapy interventions: a systematic review
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Abstract
Background and objectives: Myofascial pain syndrome, provoked by myofascial trigger points (MTrPs), is a common cause of musculoskeletal pain. Accurate identification of MTrPs remains difficult due to its subjective clinical assessment. B-mode ultrasound (US) offers a promising alternative for characterizing MTrPs, although its clinical utility remains uncertain. This study aimed to evaluate the evidence supporting B-mode US to characterize MTrPs, assess changes in muscle architecture, and analyze the impact of physiotherapeutic interventions.
Methods: A systematic review was registered in PROSPERO following PRISMA guidelines (CRD42024596408). PubMed, Scopus and Web of Science databases were searched in October 2024. Variables of interest included MTrP characteristics (hypo/hyperechoic areas, dimensions, and morphology), muscle architecture (e.g., muscle thickness or pennation angle), and ecotexture analysis (first-, second-, and higher-order features).
Results: From 28 eligible studies and 929 participants, MTrPs were consistently identified as predominantly hypoechoic nodules with heterogeneous echotexture and elliptical shapes, with areas from 0.02 to 3.4 cm². Variations in muscle architecture, such as reduced thickness, and echotexture, mainly characterized by reduced echogenicity, were frequent in affected muscles by MTrPs. Physiotherapy interventions showed variable efficacy in altering MTrP characteristics depending on the intervention type and population. Methodological quality ranged from poor/low to good/high, with a moderate risk of bias.
Discussion: This review highlights the potential of B-mode US as an assessment tool for MTrPs. However, inconsistencies in imaging protocols, limited quantitative analyses, and the intrinsic characteristics of the included study designs, make it difficult to draw definitive conclusions.
Conclusions: Although B-mode US shows promise in characterizing MTrPs, methodological limitations highlight the need for further studies of higher methodological quality. Standarizing US assessment protocols for MTrPs could improve diagnostic accuracy and treatment monitoring and benefit clinical practice.
Keywords
- Myofascial Trigger Point
- Systematic Review
- musculoskeletal pain
- ultrasonography
- physical therapy
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