Reliability of quantitative sensory testing on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain

SUMMARY OBJECTIVE: The objective of this study was to measure the intra- and inter-rater reliability of the quantitative sensory testing for measuring the thermal pain threshold on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. METHODS: Thirty female participants were included, aged between 18 and 45 years and with bilateral myofascial trigger points, active and centrally located in the upper trapezius muscle. Two measurements with quantitative sensory testing were performed by each examiner at an interval of 1 week between them. RESULTS: We observed substantial reliability for the intra-rater analysis (intraclass correlation coefficient ranging between 0.876 and 0.896) and excellent reliability for the inter-rater analysis (intraclass correlation coefficient ranging between 0.917 and 0.954). CONCLUSION: The measurement of the thermal pain threshold on myofascial trigger points in individuals with chronic neck pain has acceptable reliability values, supporting the use of the quantitative sensory testing in the research setting and the clinical environment.

Avaliação eletromiográfica da musculatura mastigatória e da coluna cervical com uso de placa oclusal: relato de caso / Electromyographic evaluation of masticatory and cervical musculature with occlusal splint: case report

Objetivo: Avaliar a atividade elétrica de músculos mastigatórios e cervicais e sua inter-relação na estabilização da cadeia crânio cervico umeral com uso da placa oclusal, por meio da avaliação eletromiográfica. Relato de caso: Paciente sexo feminino, 39 anos, queixando-se de dores na cabeça, faciais e cervicais, com prejuízo em suas atividades diárias. Relatou apertar os dentes durante o dia e a noite e ser uma pessoa muito ansiosa. Pratica exercício físico de 5 a 6 vezes por semana. Foi submetida ao tratamento com placa oclusal estabilizadora. O exame eletromiográfico foi realizado nos músculos masseter e trapézio, bilateralmente. A coleta de dados foi realizada antes da instalação da placa e passados 90 dias de uso. Considerações finais: Após o tempo de tratamento, foi relatado redução do comportamento de apertamento noturno e diurno dos dentes, redução do nódulo muscular antes visível na região supraescapular, eliminação das dores e melhor rendimento muscular durante a prática de atividade física.(AU)

Objective: To evaluate the electrical activity of masticatory and cervical muscles and their relationship in the stabilization of the craniocervicohumeral chain using a occlusal splint, through electromyographic evaluation. Case report: Female patient, 39 years old, complaining of headaches, facial and cervical pain, with impairment in her daily activities. She reported teeth clenching during the day and night, and being a very anxious person. She practices physical exercise 5 to 6 times a week. She underwent treatment with a stabilizing occlusal splint. The electromyographic examination was performed on the masseter and trapezius muscles, bilaterally. Data was collected before occlusal splint installation and after 90 days of use. Final considerations: After the treatment period, it was reported a reduction in the behavior of nocturnal and daytime teeth clenching, reduction of the muscle nodule previously visible in the suprascapular region, elimination of pain and better muscle performance during the practice of physical activities.(AU)

Clinical features of patients with chronic non-specific neck pain per disability level: A novel observational study

BACKGROUND To date, there are no cross-sectional studies considering the influence of disability level in patients with non-specific chronic neck pain. Therefore, the main aim of this study was to determine kinesiophobia, active cervical range of movement (CROM), and pressure pain threshold (PPT) differences between different disability levels (mild, moderate, and severe) in subjects with non-specific chronic neck pain and asymptomatic subjects. METHODS A descriptive cross-sectional study. Subjects were recruited from a primary health care center and an outpatient department hospital. A total sample of 128 subjects, 96 of them with nonspecific chronic neck pain and 32 asymptomatic, were recruited. The NDI was used to divide the subjects with chronic neck pain into 3 groups (mild, moderate, and severe disability). The main outcome measurement was the Tampa Scale of kinesiophobia (TSK-11). The secondary outcome measurements were the Visual Analogue Scale (VAS), PPT (trapezius and tibialis anterior), CROM (flexion, extension, rotation, and lateral inclination) and pain duration. RESULTS The ANOVA results revealed, in the comparisons between groups, statistically significant differences for the VAS between the mild-severe (P < 0.01) and moderate-severe groups (P < 0.01), but not between the mild-moderate groups (P > 0.05); for the TSK, differences were not statistically significant (P > 0.05). CONCLUSION Kinesiophobia may not be influenced by disability level in patients with chronic non-specific neck pain. Nevertheless, pain intensity and chronicity of patients with severe neck disability are increased with respect to mild and moderate disability index.

RESUMO CONTEXTO Até a data, não há estudos transversais considerando a influência do nível de incapacidade em pacientes com dor de garganta crônica não específica. Portanto, o objetivo principal deste estudo foi determinar a diferença entre os níveis de diminuição do colesterol cervical (Crom) e o limiar por dor de pressão (PPT) entre diferentes níveis de incapacidade (leve, moderada e grave) em indivíduos com dor crônica não específica no pescoço e sujeitos assintomáticos. MÉTODOS Estudo descritivo transversal. Os indivíduos foram recrutados de um centro de saúde primário e de um hospital do departamento ambulatorial. Uma amostra total de 128 indivíduos, 96 indivíduos com dor no pescoço crônica não específica e 32 indivíduos assintomáticos, foi recrutada. O NDI foi usado para dividir os indivíduos com dor no pescoço crônica em três grupos (incapacidade leve, moderada e grave). A principal medida de resultados foi a Tampa Scale of Kinesiophobia (TSK-11). As medidas de resultado secundário foram a Escala Analógica Visual (VAS), PPT (trapézio e tibial anterior), Crom (flexão, extensão, rotação e inclinação lateral) e duração da dor. RESULTADOS Nos resultados da Anova revelados nas comparações entre os grupos, diferenças estatisticamente significativas para o VAS foram observadas entre os grupos leve-grave (P<0,01) e moderado-grave (P<0,01), mas não entre os grupos moderado-moderado (P>0,05). Para o TSK, as diferenças não foram estatisticamente significativas (P>0,05). CONCLUSÃO A cinesiofobia pode não ser influenciada pelo nível de incapacidade em pacientes com dor no pescoço crônica não específica. No entanto, a intensidade da dor e a cronicidade de pacientes com deficiência grave do pescoço são aumentadas em relação ao índice de incapacidade leve e moderada.

Myofascial trigger points in patients with temporomandibular joint disc displacement with reduction: a cross-sectional study

Abstract Objective The objective of this retrospective study was to evaluate the impact of myofascial trigger points (MTrPs) in patients with articular disc displacement with reduction (DDWR) and to identify which clinical variables are associated with the concomitant presence of DDWR and MTrPs. Material and Methods 130 patients were selected that sought treatment due to joint pain, with ages ≥18 years, of both genders, with DDWR confirmed by magnetic resonance imaging. The sample was divided into two groups: Group 1, patients with DDWR and MTrPs (N=101); and Group 2, patients with DDWR and no MTrPs (N=29). Information on gender, age, pain duration, pain scores, and maximal interincisal distance (MID) were collected. The logistic regression model was used and the odds ratios (OR) was calculated (p<0.05). Results Group 1 presented statistically significant higher mean pain scores (p=0.007), and smaller MID (p=0.0268) than Group 2. OR were significant for the pain scores (1.429), MID (0.937) and gender (women) (2.810). Conclusions Patients with DDWR and MTrPs had increased pain scores and a MID decrease compared to patients with DDWR and no MTrPs. The variables pain scores, MID, and gender (women) showed a significant association with the concomitant presence of DDWR and MTrPs.

Intra and inter-rater reliability of infrared image analysis of masticatory and upper trapezius muscles in women with and without temporomandibular disorder / Confiabilidade intra e interexaminador da análise de imagens infravermelhas dos músculos mastigatórios e trapézio superior em mulheres com e sem disfunção temporomandibular

BACKGROUND: Infrared thermography is an aid tool that can be used to evaluate several pathologies given its efficiency in analyzing the distribution of skin surface temperature. OBJECTIVES: To propose two forms of infrared image analysis of the masticatory and upper trapezius muscles, and to determine the intra and inter-rater reliability of both forms of analysis. METHOD: Infrared images of masticatory and upper trapezius muscles of 64 female volunteers with and without temporomandibular disorder (TMD) were collected. Two raters performed the infrared image analysis, which occurred in two ways: temperature measurement of the muscle length and in central portion of the muscle. The Intraclass Correlation Coefficient (ICC) was used to determine the intra and inter-rater reliability. RESULTS: The ICC showed excellent intra and inter-rater values for both measurements: temperature measurement of the muscle length (TMD group, intra-rater, ICC ranged from 0.996 to 0.999, inter-rater, ICC ranged from 0.992 to 0.999; control group, intra-rater, ICC ranged from 0.993 to 0.998, inter-rater, ICC ranged from 0.990 to 0.998), and temperature measurement of the central portion of the muscle (TMD group, intra-rater, ICC ranged from 0.981 to 0.998, inter-rater, ICC ranged from 0.971 to 0.998; control group, intra-rater, ICC ranged from 0.887 to 0.996, inter-rater, ICC ranged from 0.852 to 0.996). CONCLUSION: The results indicated that temperature measurements of the masticatory and upper trapezius muscles carried out by the analysis of the muscle length and central portion yielded excellent intra and inter-rater reliability.

CONTEXTUALIZAÇÃO: A termografia infravermelha vem sendo utilizada como instrumento auxiliar na avaliação de patologias diversas, dada a sua eficiência na investigação da distribuição da temperatura superficial cutânea. OBJETIVOS: Propor duas formas de análise das imagens infravermelhas dos músculos mastigatórios e trapézio superior e determinar a confiabilidade intra e interexaminador dessas duas formas de análise. MÉTODO: Foram coletadas imagens infravermelhas dos músculos mastigatórios e trapézio superior de 64 voluntárias do gênero feminino, com e sem disfunção temporomandibular (DTM). A análise das imagens infravermelhas ocorreu de duas formas: mensuração da temperatura da extensão do músculo e do centro do músculo, sendo realizada por dois examinadores. A confiabilidade intra e interexaminador foi verificada por meio do Coeficiente de Correlação Intraclasse (CCI). RESULTADOS: Os valores do CCI intra e interexaminador foram considerados excelentes em ambas as avaliações: análises da extensão do músculo (grupo DTM, intraexaminador, CCI variou de 0,996 a 0,999, interexaminador, CCI variou de 0,992 a 0,999; grupo controle, intraexaminador, CCI variou de 0,993 a 0,998, interexaminador, CCI variou de 0,990 a 0,998) e análise do centro do músculo (grupo DTM, intraexaminador, CCI variou de 0,981 a 0,998, interexaminador, CCI variou de 0,971 a 0,998; grupo controle, intraexaminador, CCI variou de 0,887 a 0,996, interexaminador, CCI variou de 0,852 a 0,996). CONCLUSÃO: O estudo evidenciou que a mensuração da temperatura dos músculos mastigatórios e trapézio superior, realizada por meio da análise da extensão e do centro do músculo, apresentou excelente confiabilidade intra e interexaminador.