ABSTRACT
Purpose: The purpose of this paper is to evaluate the efficacy of a multimodal, outpatient neuromuscular protocol in treating remaining sensitization and myofascial pain in endometriosis patients post-surgical excision. Patients and Methods: A retrospective longitudinal study was conducted for women aged 22 to 78 with a history of surgically excised endometriosis. 60 women with an average duration of pain of 8.63 ± 7.65 years underwent a treatment protocol consisting of ultrasound guided trigger point injections, peripheral nerve blocks, and pelvic floor physical therapy for 6 weeks. Concomitant cognitive behavioral therapy once weekly for a total of 12 weeks was also undertaken. Pain intensity and pelvic functionality were assessed at new patient consults and 3-month follow ups using Visual Analogue Scale (VAS) and Functional Pelvic Pain Scale (FPPS). Results: At new patient consults, average VAS and FPPS were 7.45 ± 2.11 (CI 6.92-7.98) and 14.35 ± 6.62 (CI 12.68 -16.02), respectively. At 3-month follow ups, average VAS and FPPS decreased to 4.12 ± 2.44 (CI 3.50-4.73; p < 0.001) and 10.3 ± 6.55 (CI 8.64-11.96; p < 0.001), respectively. Among FPPS categories, sleeping, intercourse, and working showed the highest statistical significance. Conclusion: Data suggests the multimodal protocol was effective in treating the remaining underlying sensitization and myofascial pain seen in Endometriosis patients post-surgical excision, particularly in decreasing pain and improving function during work and intercourse.
ABSTRACT
OBJECTIVE: The purpose of this study was to use MRI of the shoulder to analyze the axillary arch muscle and its anatomic relations to lymph nodes and the brachial plexus. MATERIALS AND METHODS: In this retrospective study at a single clinic, five observers blinded to the patient's condition assessed images from 1,109 consecutive initial shoulder MRI examinations for the presence and anatomic relations of the axillary arch. MRI interpretation reports were reviewed for documentation of previous injuries and upper extremity radicular pain or numbness for possible correlations between presence of the arch and symptoms of nerve entrapment. Results were reported as prevalence percentage or mean ± SD with 95% CI. Groups were compared by use of Student's t test or chi-square test as indicated (p < 0.05). RESULTS: An arch muscle was found in 71 of 1,109 (6%) examinations, and variability was found in arch insertion and visualization. A statistically significant 65 of 71 (92%) arches had a course superficial to the lymph nodes. The insertion of 50 of 71 (70%) arches was within 5 mm of the brachial neurovascular bundle. Excluding documented injuries, significantly more patients with an arch had upper extremity neurologic abnormalities than did patients without an arch (p = 0.02). CONCLUSION: The axillary arch muscle is situated in such a way that it can conceal lymph nodes and impinge on the brachial plexus, causing symptoms of upper extremity nerve entrapment. Radiologists' familiarity with the arch can improve their recognition of this muscular variant so that they can communicate appropriate clinical correlations to referring physicians.
