Ultrasoundimagingandguidanceinthemanagementofmyofascialpainsyndrome:anarrativereview

Myofascial pain syndrome (MPS) is an extremely common musculoskeletal condition, estimated to affect up to 85% of the general population depending on diagnostic criteria. It is characterized by localized muscle pain, tenderness, and trigger points—hyperirritable spots within muscle tissue or fascia that can cause significant disability and reduced quality of life. Common trigger point locations include the upper trapezius, levator scapulae, rhomboids, quadratus lumborum, and infraspinatus muscles. Despite its prevalence, MPS remains challenging to diagnose and treat effectively.

Traditional approaches rely heavily on physical palpation, which can be subjective and imprecise. Ultrasonography has emerged as a promising tool that could improve both the accuracy of diagnosis and the precision of treatments, but clinicians need clear guidance on how to apply it across different clinical scenarios involving MPS.

This narrative review systematically searched four major medical databases (PubMed, Scopus, Embase, and Web of Science) through April 1, 2024, using search terms including "myofascial pain," "trigger point," "ultrasound," and "sonography." The authors included human studies that used ultrasound for either assessment or guided treatment of MPS, excluding animal studies, non-ultrasound imaging methods, studies without measurable clinical outcomes, and studies not focused on MPS patients. From this search, they identified and synthesized findings across seven key topic areas: (1) sonoelastography for upper trapezius MPS, (2) ultrasound-guided interfascial hydrodissection with visual feedback, (3) ultrasound-guided rhomboid interfascial plane blocks, (4) ultrasound-guided perimysium dissection for posterior shoulder MPS, (5) combined shockwave therapy with lidocaine injection for trapezius MPS, (6) various injection targets for MPS, and (7) ultrasound-guided delivery of local anesthetics and steroids for quadratus lumborum MPS.

The review identified several clinically relevant findings from the included studies. Hao et al. (2023) found that shear-wave elastography could distinguish MPS patients from non-MPS controls, with area under the curve values of 0.899 for moderate pain and 0.983 for severe pain, and sensitivity of 86.27% and specificity of 62.07% for upper trapezius assessment. Suarez-Ramos et al.

(2023) demonstrated that ultrasound-guided interfascial hydrodissection with self-stretch exercises showed more significant effect sizes on visual analog scale pain scores compared to dry needling with self-stretch exercises in 46 participants, with improvements sustained up to 6 months. Hasuo et al. (2022) found that visual feedback during ultrasound-guided hydrodissection significantly enhanced treatment expectations and resulted in 67.7% of patients achieving 50% or greater improvement in numeric rating scale pain scores at 14 days, versus 36.6% in the non-visual feedback group. Ozyemisci Taskiran et al.

(2023) reported that ultrasound-guided rhomboid interfascial plane blocks produced significant pain reduction in approximately 90% of 23 patients at 1 week, 60-70% at 1 month, and 50% at 1 year. Lai et al. (2021) found that ultrasound-guided perimysium dissection in 57 patients resulted in 33.3% becoming pain-free and 56.1% achieving over 50% improvement, with mean VAS scores decreasing from 7.18±1.60 to 1.91±2.04. Anwar et al.

(2022) showed that combining extracorporeal shockwave therapy with ultrasound-guided trigger point injection of lidocaine produced more pronounced reduction in elastic stiffness at 4 weeks compared to shockwave alone. Barreto Silva et al. (2023) demonstrated that ultrasound-guided injection of levobupivacaine and triamcinolone for quadratus lumborum MPS in 90 participants produced pain improvements lasting up to 3 months and sustained at 6 months.

This review establishes ultrasound as a versatile and valuable tool across the full spectrum of MPS care—from diagnosis through treatment. For clinicians, the key practical message is that ultrasound guidance can enhance both accuracy and safety when performing interventions for MPS. The technology allows real-time visualization of needle placement, helping avoid complications and ensuring precise delivery of treatments to target tissues. Specific techniques like interfascial hydrodissection, interfascial plane blocks, and perimysium dissection represent advanced applications that may offer advantages over conventional trigger point injections or dry needling alone.

The finding that visual feedback during procedures can enhance patient expectations and improve outcomes suggests a psychological component that clinicians can leverage. For patients, this means that seeking providers who use ultrasound-guided techniques may lead to better results with fewer risks. The sustained benefits reported at 6 months and even 1 year for some interventions also suggest that these approaches may provide durable relief rather than merely temporary symptom management. However, the review appropriately notes that many included studies were single-arm or small randomized trials, indicating that larger, more rigorous comparative studies are still needed to definitively establish optimal approaches for different MPS presentations.