The difference in the upper trapezius deep fascia slides between individuals with and without myofascial pain syndrome: A case-control study.

INTRODUCTION: MPS is a chronic disorder caused by myofascial trigger points, leading to pain and limited neck movements due to impacted fascia. Studies have reported reduced fascia slides in chronic low back pain, but limited fascia slides in MPS patients are still unreported. AIM: We determined differences in upper trapezius' deep fascia slides between MPS and non-MPS participants. METHODS: Between January-August 2019, participants from diverse work sectors were recruited in Manila. An expert physiotherapist diagnosed MPS, while non-MPS participants performed full painless cervical movements. Participants underwent upper trapezius deep fascia scans on both shoulders while performing six cervical movements. An HS1 Konica Minolta ultrasound recorded the data. Two blinded physiotherapists used Tracker 5.0 © 2018 to analyze videos and quantify deep fascia slides by measuring the distance between two x-axis points. The Multivariate analysis of variance (MANOVA) assessed deep fascia slide differences in six active cervical movements. Pillai's Trace, with a range of 0-1 and a p-value of <0.05, was set. Effect sizes in individuals with and without MPS were calculated using Hedges' g and Cohen's d. RESULTS: Of the 327 participants (136 non-MPS, 191 MPS), 101 MPS participants had shoulder pain for <1 year and 103 experienced unilateral pain. The study examined 3800 ultrasound videos but found no significant difference in deep fascia slides across cervical movements between MPS and non-MPS groups (Pillai's Trace = 0.004, p = 0.94). Minor differences in deep fascia displacement were observed, with small effect sizes (g = 0.02-0.08). CONCLUSION: A limited deep fascia slide does not characterize MPS participants from non-MPS participants.

Effectiveness of constraint-induced movement therapy (CIMT)-Telerehabilitation compared to traditional CIMT on upper extremity dysfunction of adult chronic stroke patients-A systematic review and meta-analysis.

BACKGROUND/OBJECTIVE: Constraint-induced movement therapy (CIMT), a therapy that encourages the use of the affected upper limb through intensive functional tasks, effectively promotes upper limb function in patients with chronic stroke. This study determined the effectiveness of CIMT using telerehabilitation compared with traditional CIMT in improving mild to moderate upper limb motor function in adult patients with chronic stroke. METHODS: Eligible studies were identified by searching electronic databases and scanning the reference lists of articles. Review Manager 5.4 was used to determine the pooled mean effect size of the standardized mean difference and 95% confidence interval for the group comparison. Visual heterogeneity, I2 statistic, and chi-square test were used to measure the heterogeneity between the included studies. We evaluated the quality of evidence using GRADEpro GDT, software for creating evidence summaries and healthcare recommendations. RESULTS: Two randomized controlled trials were included in this review. A total of 109 participants (70 male, 39 female) were evaluated. The time since the stroke was ≥6 months in one study and ≥1 year in another study. Improvements in upper limb motor function while performing functional movements were measured using the Wolf Motor Function Test. The evidence for the effectiveness of CIMT using telerehabilitation compared with traditional CIMT in improving the upper extremity function in patients with chronic stroke is of moderate quality. This suggests no significant difference between the groups (mean difference [95% CI]: -0.04 [-0.42, 0.33]). CONCLUSIONS: CIMT using telerehabilitation is not superior to traditional CIMT in improving patients' upper extremity motor function with chronic stroke. CIMT using telerehabilitation may improve access to treatment, minimize SARS-CoV-2 risk, and reduce travel in patients with chronic stroke.

Superficial fascia displacement in cervical flexion: differentiating myofascial pain syndrome, a cross-sectional study.

CONTEXT: Myofascial pain syndrome (MPS) is primarily characterized by myofascial trigger points related to fascial adhesions. MPS hinders fascial flexibility and mobility, leading to myofascial limitations, dysfunctional movement, and limitation of motion (LOM). OBJECTIVES: This study determined the association of age, sex, type of work, symptom chronicity, symptom laterality, cervical LOM, altered direction of fascial displacement, and magnitude of superficial fascial displacement during active cervical flexion with the clinical diagnosis of MPS. METHODS: A cross-sectional study selectively included MPS and non-MPS participants from different workplaces from January to October 2019. The MPS group exhibited clinical symptoms like tender spots, recognized pain patterns, and local twitch response upon palpation, often accompanied by cervical LOM. The non-MPS group lacked these symptoms, and those with certain pre-existing conditions or recent physiotherapy were not part of the study. Participants performed cervical active range of motion (AROM) while a sonographer recorded superficial fascial displacement utilizing ultrasound, which was later analyzed by three physiotherapists with the Tracker. Aiming for a multiple regression R-squared of 0.2, the target was 384 participants to account for a 20 % dropout, resulting in 307 participants after attrition. To explore the relationships between MPS and various factors, logistic regression models, rigorously tested for reliability and validity, were utilized. RESULTS: In the study, there were 192 participants with MPS and 137 without MPS. The median ages were 33 years for the non-MPS group and 38 years for the MPS group. The adjusted model found significant links for sex (odds ratio [OR]=2.63, p<0.01), symptom chronicity (OR=8.28, p<0.01), and cervical LOM (OR=3.77, p=0.01). However, age and the presence of nodules/taut bands were not statistically significant (p>0.05). Also, the type of work, the direction of fascial displacement, and the difference in superficial fascial displacement during cervical flexion did not show a significant association with the clinical diagnosis of MPS (p>0.05). The adjusted model had a sensitivity of 73.80 % and a specificity of 81.34 %, correctly identifying 84.66 % of positive cases and 68.99 % of negative ones, resulting in an overall accuracy of 76.95 % in predicting MPS. CONCLUSIONS: We provided an in-depth examination of MPS, identifying sex, duration of symptoms, and cervical LOM as significant predictive factors in its diagnosis. The study emphasizes the critical role of these variables in the accurate diagnosis of MPS, while delineating the comparatively minimal diagnostic value of other factors such as age, type of occupation, presence of nodules or taut bands, and variations in fascial displacement. This study underscores the imperative for further scholarly inquiry into the role of fascial involvement in musculoskeletal disorders, with the objective of enhancing both the theoretical understanding and diagnostic practices in this medical domain.

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 effects of taping on de Quervain's disease: A systematic review and meta-analysis.

BACKGROUND: Therapeutic taping may be a useful modality in relieving pain, improving strength, and restoring the function of patients with De Quervain's Disease (DQD). Evidence on the effectiveness of therapeutic taping for DQD patients in mitigating its clinical signs and symptoms is not established. However, reviews report Kinesio Taping effects on musculoskeletal pains not specific to DQD. METHODS: The study followed the guideline statement of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two researchers (RD and SN) searched the electronic databases and hand-searched for relevant journals. The relevant articles were selected using keywords found in titles and abstracts and, consequently, full-text manuscripts. A third researcher (VCDIII) resolved the disagreements between the two researchers. They used Review Manager 5.4 for risk of bias assessment and meta-analysis. Data were pooled to determine the therapeutic taping's overall effect. Heterogeneity was assessed by Higgin's (I2) statistic. The random-effects model was used if heterogeneity was high (>60%). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach determined the certainty of evidence. RESULTS: Seven high-risk of bias clinical-controlled trials comprising 241 participants were included in the meta-analysis. The reported outcome measures were the Visual Analogue Scale (VAS) for pain, Patient-Rated Wrist/Hand Examination for Function and Power, and precision grip strength using a hand-held dynamometer and pinch gauge. Therapeutic taping did not improve the pain, power grip, grip strength, and function of participants with DQD (p > 0.05). Therapeutic taping compared to other physical therapy interventions did not reduce the VAS scores of 241 participants with DQD [SMD (95% CI) = -1.08 (-2.55,0.39), p = 0.15]. Kinesio taping with low-level laser therapy compared to ultrasound and exercise did not improve the function of 60 participants with DQD [SMD (95% CI) = 0.56 (-4.71,3.60), p = 0.79]. Therapeutic taping compared to ultrasound and Mulligan Pain Releasing Phenomenon did not improve the power grip strength of 50 participants with DQD [SMD (95% CI) = 1.24 (-0.83,3.31), p = 0.24]. Therapeutic taping was not better than phonophoresis in improving the precision grip strength of 50 participants with DQD [SMD (95% CI) = 0.43 (-1.95,2.80), p = 0.72]. CONCLUSIONS: There is insufficient evidence to recommend the use of therapeutic taping in treating patients with DQD. Therapeutic taping was no better than other treatment modalities in mitigating the clinical signs and symptoms of DQD (p > 0.05). Therapeutic taping did not affect wrist pain, handgrip, pincer strength, and function of participants with DQD (p > 0.05).

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.

Radial nerve measurements in nonsymptomatic upper extremities of Filipinos: A cross-sectional study.

INTRODUCTION: Despite reports on the association of radial nerve (RN) size and lateral epicondylalgia (LE), Filipino normative values on RN size in healthy elbows are not established. An association with upper extremity anthropometric measurements is likewise not reported. METHODS: Musculoskeletal ultrasound measurements of the RN at the level of the lateral epicondyle (RN-LE), posterior interosseous nerve at the level of the radial head and supinator (PIN-RH and PIN-sup), and superficial RN (SRN) in the elbows of healthy Filipinos were made in Manila from January-September 2011. RESULTS: A total of 198 elbows of 99 healthy participants aged 43 years (range, 33-48 years) [median(IQR)] were investigated. Men have larger PIN-RH, PIN-sup, and SRN compared with women. Arm length was associated with PIN-RH, PIN-sup, and SRN (P < 0.05). Activities and elbow circumference measurements (at 2 levels) were associated with PIN-RH. CONCLUSIONS: RN reference values can now be used for comparison in elbows with LE.

The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review.

BACKGROUND: Ultrasound is considered a reliable, widely available, non-invasive and inexpensive imaging technique for assessing soft tissue involvement in Lateral epicondylalgia. Despite the number of diagnostic studies for Lateral Epicondylalgia, there is no consensus in the current literature on the best abnormal ultrasound findings that confirm lateral epicondylalgia. METHODS: Eligible studies identified by searching electronic databases, scanning reference lists of articles and chapters on ultrasound in reference books, and consultation of experts in sonography. Three reviewers (VCDIII, KP, KW) independently searched the databases using the agreed search strategy, and independently conducted all stages of article selection. Two reviewers (VCDIII, KP) then screened titles and abstracts to remove obvious irrelevance. Potentially relevant full text publications which met the inclusion criteria were reviewed by the primary investigator (VCDIII) and another reviewer (CGS). RESULTS: Among the 15 included diagnostic studies in this review, seven were Level II diagnostic accuracy studies for chronic lateral epicondylalgia based on the National Health and Medical Research Council Hierarchy of Evidence. Based from the pooled sensitivity of abnormal ultrasound findings with homogenous results (p > 0.05), the hypoechogenicity of the common extensor origin has the best combination of diagnostic sensitivity and specificity. It is moderately sensitive [Sensitivity: 0.64 (0.56-0.72)] and highly specific [Specificity: 0.82 (0.72-0.90)] in determining elbows with lateral epicondylalgia. Additionally, bone changes on the lateral epicondyle [Sensitivity: 0.56 (0.50-0.62)] were moderately sensitive to chronic LE. Conversely, neovascularity [Specificity: 1.00 (0.97-1.00)], calcifications [Specificity: 0.97 (0.94-0.99)] and cortical irregularities [Specificity: 0.96 (0.88-0.99)] have strong specificity for chronic lateral epicondylalgia. There is insufficient evidence supporting the use of Power Doppler Ultrasonogrophy, Real-time Sonoelastography and sonographic probe-induced tenderness in diagnosing LE. CONCLUSIONS: The use of Gray-scale Ultrasonography is recommended in objectively diagnosing lateral epicondylalgia. The presence of hypoechogenicity and bone changes indicates presence of a stressed common extensor origin-lateral epicondyle complex in elbows with lateral epicondylalgia. In addition to diagnosis, detection of these abnormal ultrasound findings allows localization of pathologies to tendon or bone that would assist in designing an appropriate treatment suited to patient's condition.