Evaluation of Radial Extracorporeal Shock Wave Therapy on Treatment-Resistant Trigger Points Using Sonographic Shear Wave Elastography

Abstract

Objective: To assess the effectiveness of radial extracorporeal shock wave therapy (rESWT) on treatment-resistant myofascial trigger points (MTrPs) in the upper trapezius and evaluation of treatment efficacy by Sonographic Shear Wave Elastography (SWE) objectively. Study Design: An experimental study. Place and Duration of the Study: Department of Physical and Rehabilitation Medicine and Department of Radiology of Acibadem University Atakent Hospital, from August 2020 to June 2021. Methodology: Forty-one patients with 70 active treatment-resistant trigger points in their upper trapezius muscles were included. The treatment involved rESWT with 1500 pulses, administered at 8 Hz and 1.5 bar pressure. Of the 1500 pulses, 1000 impulses targeted MTrPs, while 500 impulses were applied to the surrounding taut band. The treatment sessions were conducted at 1-week interval until the Visual Analog Score (VAS) reached below 2 or a maximum of 5 sessions. Baseline assessments of VAS, Neck Disability Index (NDI), and shear modulus of the upper trapezius MTrPs were performed and reevaluated after the last treatment sessions. Furthermore, a follow-up assessment of the VAS was conducted after a period of 3 months for long-term effects. Results: There was a significant improvement in both NDI scores and pain relief between the pretreatment and posttreatment periods. Moreover, the shear modulus of the upper trapezius MTrPs showed a significant decrease from 41.5 kPa to 30 kPa after the treatment. Conclusion: The treatment effectively alleviated pain, improved neck function, and reduced the shear modulus of the affected areas. SWE offered a reliable real-time measurement of soft tissue stiffness, providing valuable insights into the treatment's efficacy.