Objectives The aim of the literature review was to investigate the criteria adopted by "experts" to diagnose myofascial trigger point (MTrP) pain syndrome. Experts were defined as being either researchers investigating MTrP pain syndrome or the "authority" the researchers cited as a source of reference for MTrP pain syndrome diagnosis. Methods We searched electronic databases to identify relevant empirical research (excluding studies not in English and those relating to dental pathology). Of 607 possibly relevant publications 93 met our inclusion criteria. We recorded (1) the individual criterion and criteria combinations used to diagnose MTrP pain syndrome; (2) the cited "authoritative" publications and (3) the criteria recommended by the authoritative publications as being essential for MTrP pain syndrome diagnosis. Results The review identified 19 different diagnostic criteria. The 4 most commonly applied criteria were: "tender spot in a taut band" of skeletal muscle, "patient pain recognition," "predicted pain referral pattern," and "local twitch response." There was no consistent pattern to the choice of specific diagnostic criteria or their combinations. However, one pair of criteria "tender point in a taut band" and "predicted or recognized pain referral" were used by over half the studies. The great majority of studies cited publications by Travell and more recently Simons as a principal authoritative source for MTrP pain syndrome diagnosis, yet most of these studies failed to apply the diagnostic criteria as described by these authorities. Discussion We conclude that there is as yet limited consensus on case definition in respect of MTrP pain syndrome. Further research is needed to test the reliability and validity of diagnostic criteria. Until reliable diagnostic criteria have been established, there is a need for greater transparency in research papers on how a case of MTrP pain syndrome is defined, and claims for effective interventions in treating the condition should be viewed with caution.

Variability of criteria used to diagnose myofascial trigger point pain syndrome--evidence from a review of the literature.

Myofascial pain syndrome (MPS) is described as the muscle, sensory, motor, and autonomic nervous system symptoms caused by stimulation of myofascial trigger points (MTP). The participation of fascia in this syndrome has often been neglected. Several manual and physical approaches have been proposed to improve myofascial function after traumatic injuries, but the processes that induce pathological modifications of myofascial tissue after trauma remain unclear. Alterations in collagen fiber composition, in fibroblasts or in extracellular matrix composition have been postulated. We summarize here recent developments in the biology of fascia, and in particular, its associated hyaluronan (HA)-rich matrix that address the issue of MPS.

Fascial Components of the Myofascial Pain Syndrome

Objectives To review the efficacy of the current diagnostic methods of acute compartment syndrome (ACS) after leg fractures. Data sources A Medline (PubMed) search of the English literature extending from 1950 to May 2007 was performed using "compartment syndromes" as the main key word. Also a manual search of orthopaedic texts was performed. Study selection and extraction The results were limited to articles involving human subjects. Of 2605 primary titles, 489 abstracts limited to compartment syndromes in the leg and 577 articles related to the diagnosis of compartment syndromes were identified and their abstracts reviewed. Further articles were identified by reviewing the references. Sixty-six articles were found to be relevant to diagnostic techniques for compartment syndrome in the leg and formed the basis of this review. Conclusions Early diagnosis of an ACS is important. Despite its drawbacks, clinical assessment is still the diagnostic cornerstone of ACS. Intracompartmental pressure measurement can confirm the diagnosis in suspected patients and may have a role in the diagnosis of this condition in unconscious patients or those unable to cooperate. Whitesides suggests that the perfusion of the compartment depends on the difference between the diastolic blood pressure and the intracompartmental pressure. They recommend fasciotomy when this pressure difference, known as the Delta p, is less than 30 mm Hg. Access to a precise, reliable, and noninvasive method for early diagnosis of ACS would be a landmark achievement in orthopaedic and emergency medicine.

http://www.marshall-surgery.net/wp-content/uploads/2014/04/diagnostic-techniques-in-acute-compartment-syndrome.pdf

Diagnostic techniques in acute compartment syndrome of the leg.

Magnetic resonance elastography (MRE) is capable of noninvasively quantifying the mechanical properties of skeletal muscles in vivo. This information can be clinically useful to understand the effects of pathologies on the mechanical properties of muscle and to quantify the effects of treatment. Advances in inversion algorithms quantify muscle anisotropy in two-dimensional (2D) and three-dimensional (3D) imaging. Databases of the shear stiffness of skeletal muscle have been presented in the relaxed and contracted states in the upper extremity (biceps brachii, flexor digitorum profundus, and upper trapezius), distal leg muscles (tibialis anterior, medial gastrocnemius, lateral gastrocnemius, and trapezius), and proximal leg muscles (vastus lateralis, vastus medialis, and sartorius). MRE measurements have successfully validated a mathematical model of skeletal muscle behavior in the biceps brachii, correlated to electromyographic data in the distal leg muscles and quantified the effects of pathologies on the distal and proximal leg muscles. Future research efforts should be directed toward improving one-dimensional (1D) and 3D MRE data acquisition and image processing, tracking the effects of treatment on pathologic muscle and correlating the shear stiffness with clinical measurements.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmri.20817

Applications of magnetic resonance elastography to healthy and pathologic skeletal muscle.

An integrated indenter-ARFI imaging system for tissue stiffness quantification.

Simple but objective measurement of soft tissue consistency would be advantageous in the assessment of many neurological, lymphostatic and venous disorders. The aim of the present study was to evaluate the feasibility of using a novel hand-held computerized soft tissue stiffness meter (STSM). The STSM describes the soft tissue stiffness (STS) in the form of the instantaneous force (N) by which the tissue resists the constant deformation produced by a cylindrical intender. Firstly, the STSM was used to test elastomer samples with known mechanical properties. In the in vivo assessment, 12 healthy, nondisabled adults (age range, 24-57 years) and 16 subjects with chronic myofascial neck pain syndrome (age range, 27-55 years) were studied. To study the reproducibility (coefficient of variation (CV(%))) of the method, the measurement sites were either marked with a marker pen (marked points) or localized anatomically (unmarked points). Measurements were made from the dorsal forearm (Arm), trapezius (Tra), levator scapulae (Lev), infraspinatus (Inf) and deltoideus (Del) muscle areas. STS in the forearm was studied during different types of short-term relative isometric loading of the muscle as well as during venous occlusion. STS values of the myofascial trigger points in the Lev muscles were evaluated bilaterally. A linear, positive relationship was found between the indenter force (N) and the dynamic compressive modulus (MPa) of elastomer stiffness (r(2) = 0.90, n = 9). Intra- and interrater CVs of marked and unmarked sites varied between 4.31% and 12.06%. STS increased linearly along the relative muscle load (r(2) = 0.96) and nonlinearly during the venous occlusion (r(2) = 0.97). Statistically significant regional variation of STS was found between the different measurement sites (p < 0.05). In conclusion, STSM can evaluate tissue stiffness quantitatively and yield reproducible data.

https://iopscience.iop.org/article/10.1088/0967-3334/26/3/007/pdf

Jarkko Surakka

Papers

Feasibility of the use of a novel soft tissue stiffness meter.