Objective: The aim was to evaluate effectiveness of shear wave sonoelastography is effective in detecting myofascial trigger points (MTrP) and spasticity.

Background: Ultrasound (US) revolutionized myofascial pain treatment, precise muscle dry needling (DN) under US guidance (US-DN) can multiply clinical effect [1]. Detecting spasticity on ultrasound has relevant diagnostic and therapeutic value [2]. Shear wave sonoelastography (SWE) is quantitaive US modality effective in the musculoskeletal imaging.

Method: We included 38 patients (20 females, 34±9 years old) with chronic low back pain, muscle spasticity, postural imbalance. The US-DN protocol by R. Bubnov [1] was applied: MTrP and areas of spasticity were identified according to clinical examination, referred pain pattern, US identification; single fine (28G) steel needle DN under US guidance was applied to elicit LTR and/or `needle grasp` [3]. We did SWE, M-mode to detect fasciculations and  DN on both areas. Visual analogue scale data (VAS0-10) were measured before and after procedures.

Results: MTrPs were visualized as small 2-5 mm hypoechoic structures, stiff on SWE. Active MTrPs were seen as extremely stiffer areas (SWE up to 32 KPa), latent MTrPs had moderate stiffness at 7-12 kPa; stiffness decreased after treatment to 5-7 kPa. Most effective pain decrease was measured after ultraprecise DN to hypoechoic stiff area evoking strong `needle grasp` and LTR. Areas of spasticity (non-MTrPs) we distinguished as larger areas up to 8-15 mm width and up to 60 mm length along muscle fibers, more superficial, with moderate stiffness at 6-10 kPa; stiffness decreased to 4-6 kPa, echogenicity decreased after few minutes of DN without significant effects of `needle grasp` and LTR. During DN we detected LTR and locally increased stiffness in the point of `needle grasp` on US. After DN we detected decreasing muscle stiffness, increasing echogenicity in the homogenous hypoechoic pattern appeared muscle striae, relaxation and increased motility.

Conclusion: Multimodality ultrasound using SWE is effective to evaluate case of pain and spasticity, to monitor and predict intervention outcome. SWE can provide important markers of skeletal muscle, helps to detect MTrPs, spasticity and evaluate inactivation after DN. MTrPs and spasticity are different phenomena contributing to pain, altering motion and posture.

References: 1. Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J 2012, 3(1):13. https://doi.org/10.1186/1878-5085-3-13 2. Bubnov RV. Ultrasonography for local muscle spasticity management. Mov Disord 2012, 27(Suppl 1):336. 3. Bubnov, R, Kalika L, Golubnitschaja O. (2019) “IMPLICATION OF LOCAL MUSCLE RESPONSE TO PRECISE DRY NEEDLING IN CLINICAL OUTCOMES OF TREATMENT MYOFASCIAL PAIN.” Morressier. doi: 10.26226/MORRESSIER.5D4434D506F5C40FC4487338.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/shear-wave-sonoelastography-is-effective-in-detecting-myofascial-trigger-points-and-spasticity/