Combinedeffectivenessofextracorporealradialshockwavetherapyandultrasound-guidedtriggerpointinjectionoflidocaineinuppertrapeziusmyofascialpainsyndrome

Myofascial pain syndrome (MPS) is a major musculoskeletal problem affecting the neck and shoulder region, with trigger points in the upper trapezius muscle being particularly common. These painful, taut bands of muscle can cause significant disability and affect quality of life. While both extracorporeal shockwave therapy (ESWT) and trigger point injection (TPI) have shown individual benefits for treating MPS, researchers wanted to determine if combining these treatments could provide superior results. Previous studies suggested that combination therapies might be more effective than single treatments, but no research had specifically examined radial shockwave therapy combined with ultrasound-guided lidocaine injection for upper trapezius myofascial pain.

The researchers conducted a randomized controlled trial with 45 participants aged 20-65 years who had chronic neck pain for more than three months and confirmed trigger points in the upper trapezius muscle. Participants were randomly divided into three groups of 15 each: a shockwave-only group receiving radial ESWT (1000 shots at 5 Hz frequency and 1.2 bar intensity), a combined treatment group receiving both shockwave therapy and ultrasound-guided trigger point injection with lidocaine, and a control group receiving standard care (heat therapy and exercise). All groups received three treatment sessions over three weeks. The researchers used multiple objective measurement tools including visual analog scale for pain, neck disability index for function, surface electromyography for muscle activity, shear wave elastography for muscle stiffness, and infrared thermography for skin temperature.

Assessments were conducted at baseline, one week, and four weeks.

Both the shockwave-only and combined treatment groups showed statistically significant improvements compared to the control group in pain reduction, functional disability, skin temperature, and elastic muscle stiffness. However, the combined treatment group demonstrated superior results compared to the shockwave-only group. At four weeks, pain scores on the visual analog scale showed the greatest reduction in the combined group, with statistically significant differences compared to both control (P<0.01) and shockwave-only (P<0.05) groups. The neck disability index also improved most in the combined group.

Importantly, elastic stiffness measured by shear wave elastography showed significant reduction in the combined group compared to both control (P<0.01) and shockwave-only (P<0.01) groups at four weeks. Skin temperature over trigger points decreased significantly in both treatment groups, indicating improved blood circulation and muscle relaxation. Interestingly, surface electromyography showed no significant changes in electrical muscle activity across any groups.

This study provides strong evidence that combining radial shockwave therapy with ultrasound-guided trigger point injection of lidocaine is more effective than either treatment alone for upper trapezius myofascial pain syndrome. The combination approach offers superior pain relief and functional improvement while also addressing the underlying muscle stiffness that characterizes trigger points. For patients suffering from chronic neck pain and trigger points, this combination therapy represents a promising treatment option that could provide faster and more complete recovery. For clinicians, the study demonstrates the value of multimodal treatment approaches and the importance of using objective measurement tools like sonoelastography to assess treatment effectiveness.

The use of ultrasound guidance for trigger point injections ensures accurate needle placement and potentially reduces complications compared to blind injection techniques.