Concurrent validity of palpation and musculoskeletal ultrasound in evaluating the fascia of individuals with and without myofascial pain syndrome.

BACKGROUND AND PURPOSE: Palpation evaluates the fascia, a three-dimensional web of connective tissues. We propose altered fascia system displacement in patients with myofascial pain syndrome. This study determined the concurrent validity of palpation and musculoskeletal ultrasound (MSUS) videos played on Windows Media Player 10 (WMP) when evaluating the direction of the fascia system's displacement at the end of the cervical active range of motion (AROM). METHODS: This cross-sectional study used palpation as index test and MSUS videos on WMP as reference test. First, three physical therapists palpated right and left shoulders for each cervical AROM. Second, during cervical AROM, PT-Sonographer recorded the fascia system displacement. Third, using the WMP, the physical therapists evaluated the direction of skin, superficial and deep fascia displacements at the end of cervical AROM. MedCalc Version 19.5.3 determined the "exact" Clopper-Pearson Interval (CPI). RESULTS: We found strong accuracy between palpation and MSUS videos on WMP when determining the direction of skin displacement during cervical flexion and extension (CPI= 78.56 to 96.89). There was moderate agreement between palpation and MSUS videos on WMP when determining the direction of the skin, superficial fascia, and deep fascia displacements during cervical lateral flexion and rotation (CPI= 42.25 to 64.13). CONCLUSION: Skin palpation during cervical flexion and extension may be useful in evaluating patients with myofascial pain syndrome (MPS). It is unclear what fascia system was evaluated when shoulders were palpated at the end of cervical lateral flexion and rotation. Palpation as diagnostic tool for MPS was not investigated.

The reliability in determining the deep fascia displacement of the upper trapezius during cervical movement: A pilot study.

BACKGROUND: Restricted shoulder fascia displacement may be an etiological factor for myofascial pain syndrome. A diagnostic ultrasound video can follow deep fascia displacement during active cervical movements. Trackers can be applied to videos to convert deep fascia displacement into data points. This study reports on assessors' reliability in evaluating direction and quantifying upper trapezius' deep fascia displacement during active cervical movements. METHODS: PT-Sonographer 1 recorded deep fascia displacement of upper trapezius for three sets using HS1 Konica Minolta diagnostic ultrasound. The recording sequence used was cervical flexion, extension, right lateral flexion, left lateral flexion, right rotation, and left rotation. The three assessors used the tracker to determine direction of deep fascia displacement. PT-Sonographer 1 used the tracker three times in quantifying deep fascia displacement. Intraclass correlation coefficient and Kappa determined the assessors' intra-tester and inter-tester reliability. RESULTS: Ten participants were included in the study with a mean±(SD) age of 37±(6). All the assessors had acceptable intra-tester reliability in determining deep fascia displacement on tracker (ICC≥0.40). All assessors had clinically unacceptable inter-tester reliability in determining deep fascia displacement when tracking right rotation (ICC < 0.40). PT-Sonographer 1 had clinically unacceptable intra-tester reliability in determining deep fascia displacement when tracking left rotation (ICC<0.40). CONCLUSION: We report clinically acceptable assessors' reliability in determining direction and total deep fascia displacement when tracking diagnostic ultrasound videos of cervical flexion, extension, and lateral flexion. Checking for reliable deep fascia displacements may distinguish MPS from non-MPS individuals increasing the utility of diagnostic ultrasound machine and tracker in clinical practice.

The effectiveness of Biomechanical Taping Technique on visual analogue scale, static maximum handgrip strength, and Patient Rated Tennis Elbow Evaluation of patients with lateral epicondylalgia: A cross-over study.

INTRODUCTION: Lateral epicondylalgia (LE) is a musculoskeletal injury involving the common extensor origin in elbow manifesting as pain and ineffective handgrip affecting the daily activities of the individuals with LE. OBJECTIVES: This study determined the effectiveness of Standard Biomechanical Taping (SBMT), Vector Correcting Dysfunction Techniques 1 (VCDT 1) and Vector Correcting Dysfunction Technique 2 (VCDT 2); and compared their differences on effects on pain, grip strength and daily functions of individual with unilateral LE. METHODS: A cross-over study design was used. The senior investigator applied three BMT techniques namely: a. SBMT, b. VCDT 1, and c. VCDT 2. On Day 1, SBMT and VCDT1 were randomly assigned. On Day 3, either SBMT or VCDT1 not performed on Day 1 was applied to LE elbows. On Day 5, VCDT2 was applied on LE elbows. Visual Analogue Scale (VAS), Static Maximum Handgrip Strength Test (SMHGT) and Patient-Rated Tennis Elbow Evaluation (PRTEE) were used as outcome measures administered by three blinded junior investigators. On Days 1, 3, and 5, VAS and SMGHT were administered before and during BMT application. PRTEE was administered on Days 1 and 12. RESULTS: The following were found in this study: a. significantly decreased VAS scores at Days 1, 3, and 5 of BMT application (p < 0.05); b. significantly improved final VAS, SMHGT strength and PRTEE scores on Day 12 compared to baseline scores on Day 1 (p = /<0.01); and c. significantly decreased VAS scores when using SBMT compared to VCDT2 (p < 0.05). CONCLUSION: BMT is a novel taping technique effective in decreasing lateral elbow pain, increasing handgrip strength and improving function of patients with LE. BMT can be applied on painful elbows effecting a better grip among patients with LE.