Treatment of myofascial syndrome of trapezoidal mucosa by the method of radial shock and shock therapy
M.V. Sikorska, Yu.K. Ременюк
Awatage Medical Center
Treatment of myofascial syndrome of trapezoidal mucosa
by the method of radial shock and shock therapy
Zaporizhia State Medical University, 2 Awatage Medical Center, Zaporizhia
Key words: myofascial syndrome, radial shock wave therapy.
The results of treatment of 32 patients with myofascial trapezius syndrome using the method of radial shock wave therapy, which allowed to obtain a more stable result in comparison with groups of patients treated by conventional methods.
In the practice of neurologists, a large number of patients with myofascial pain remain constant. In the special literature, this nosological form is often called fibromyositis, myofibrosis, myalgia, psychogenic rheumatism. Myofascial pain of an individual muscle is formed under the influence of the activity of the trigger points of the muscle and / or the associated fascia. Active trigger points can be both single and multiple in the affected muscle. The critical point is associated with pain at rest or during movement, which provokes muscle tension. The active trigger point is always painful on palpation. Trigger points can cause the development of reflected pain in areas characteristic of the affected muscle.
Myofascial pain occurs acutely or gradually. Typically, the movement that causes pain is accurately described by patients. To determine the location of the critical point, the affected muscle is briefly stretched, there is a rare tension of the affected bundle, while other adjacent fibers are relaxed. The tense beam is felt in the form of a taut cord. If you give the muscle rest, perform hot moist wraps, physiotherapy, analgesics, pain is reduced, but in the presence of any adverse effects (adverse weather, stress, exercise, etc.) myofascial pain resumes; in addition to increasing pain at the initial trigger points, the latter can multiply, forming auxiliary and secondary trigger points. Thus, the selection of adequate methods of impact on the trigger points and affected muscles remains relevant and extremely difficult.
In the last 5 years, positive results in the treatment of pain have been obtained using the method of shock wave therapy. The analgesic effect is achieved by direct exposure to trigger points, which leads to increased production of endorphins in response to irritation of pain receptors, increased blood flow and local hyperemia at the site of exposure, which intensifies the breakdown of inflammatory mediators and induces regenerative processes.
THE PURPOSE OF THE WORK
Carry out a comparative analysis of the treatment of patients using the method of shock wave therapy and the classical method.
PATIENTS AND RESEARCH METHODS
We observed 56 patients, who were divided into 2 groups. Among 32 patients of the main group there were 20 women and 12 men, the average age was 34.12 ± 3.08 years; in the control group 24 patients, including 15 women and 9 men, mean age - 32.43 ± 2.18 years. The duration of the disease in both groups ranged from 5 months to 2.5 years. All patients of the main group had previously undergone courses of drug and physiotherapy, noting their temporary effectiveness.
Patients in the control group were treated according to standard methods using drug therapy (anesthetics, nonsteroidal anti-inflammatory drugs, muscle relaxants), muscle stretching exercises, myofascial release, hot moist wraps, exposure to trigger points by ultrasound.
Trigger points were treated with a head with a diameter of 10 mm with a force of 2.5-3.0 points, a frequency of 15 Hz, the number of strokes - 1000-1500 per trigger point. After that, the trapezius muscle was exposed to shock waves with a force of 2.0 bar, a shock frequency of 12-15 Hz, the number of shocks - from 1000 to 3000. The procedures were performed on an outpatient basis with an interval of 5-10 days, the course of treatment - 5-7 procedures. During the first 2 weeks of treatment, patients were advised to reduce physical activity and perform exercises aimed at strengthening the muscles of the back, as well as swimming, massage.
Evaluation of the results of treatment was carried out in the following areas: reducing the severity of pain (according to IL Antonov): I degree - insignificant, disappears at rest; II degree - the pain which takes place at rest, amplifies at movement, but insignificant on Viranost; III degree - constant pain, periodically intensified with a senotopathic shade; IV degree - sharp, constant pain, forced position of the patient, which necessitates the urgent use of analgesics.
In addition, determined the presence and number of nodules of seals (Cornelius, Mueller, Shade), muscle seals were determined by severity based on volume and distinguished 3 degrees: I degree - single areas of the seal, occupying less than 1/3 of the muscle diameter; II degree - areas of compaction occupy up to 1/2 of the diameter of the muscle; III degree - areas of compaction occupy more than 1/2 of the diameter of the muscle.
The research results were processed by modern statistical methods of analysis on a personal computer using the statistical package of the licensed program "STATISTICA® for Windows 6.0" (StatSoft Inc., No. АХХR712D833214FAN5).
RESULTS AND DISCUSSION
Patients in the main group at the beginning of treatment according to the severity of pain belonged to III - 21 (65.6%) and IV degree - 11 (34.4%); on the severity of muscle seals, taking into account the volume to II - 15 (46.9) and III degree - 17 (51.3%) patients.
In the control group at the beginning of treatment by the degree of pain, patients were divided as follows: II degree - 3 patients (12.5%), III degree - 13 (54.1%), IV degree - 8 (33.3%) patients. By volume of muscle seals: II degree - 16 patients (66.6%), III degree - 8 patients (33.3%).
After the course of therapy, all who were under observation, noted an improvement in general condition, reduction or disappearance of pain in the neck and neck. At a palpation of trigger zones at patients of the main group pain sensations were not noted, and in control group of 6 patients (5%) insignificant painful sensations (I degree) were noted.
Patients treated with radial shock wave therapy (RSWT) reported a reduction in pain after 2.5 ± 0.7 weeks of treatment, and by the end of therapy the pain had regressed completely. Complications from the procedures were not observed.
At the follow-up examination 6 months after the end of treatment, 27 (84.3) patients of the main group showed no complaints, in the control group a positive effect was noted in 17 (70.8%) patients. These indicators refer to the disappearance of pain; 12.3% of patients in the main group (4 patients) had pain 4-6 months after the course of RSWT, which was insignificant at rest and slightly increased with movement (II degree according to IP Antonov). On palpation of the trapezius muscle, only 2 (6.3%) patients had trigger points.
In the control group, pain, as already mentioned, was experienced by 17 patients out of 24. Of these, 12 people (50%) noted that 3-4 months after treatment under the influence of adverse factors began to experience pain of the former localization and severity, 4 , 7%) of the patient associated the return of pain with increased physical activity, 1 patient (4.2%) noted the occurrence of pain after stress. Objective examination revealed trigger points in all 17 patients.
After one year, all patients under observation were re-examined. In the main group, only 7 patients (21.8%) noted the presence of back pain; at 2 of them passed at rest, at 5 pain was noted at rest and amplified at movements. All patients associated pain with a forced position (working in front of a computer, prolonged stay in one position in front of the TV). At objective examination, trigger points were determined in 4 patients (12.5%). In the control group, 19 people (79.2%) complained of intermittent or persistent back pain, and 7 of them underwent outpatient treatment with anti-inflammatory drugs. At a palpation in all cases sites of consolidation of a muscle (II-III degree) with existence of trigger points were defined.
Thus, the obtained results convincingly show that the use of RUKHT in the treatment of myofascial trapezius muscle pain allows to achieve a more pronounced and lasting effect, compared with conventional treatments.
Carrying out of treatment by a method of radial shock-wave therapy to patients with myofascial syndromes of a trapezius muscle is reasonable as promotes faster and steady reduction of painful displays.
The use of RSWT in myofascial syndromes allows to do without the use of drugs, which is especially important for patients with concomitant diseases of the gastrointestinal tract or the presence of intolerance to a number of drugs.
The use of radial shock wave therapy allows to influence the trigger points, suppressing their activity, which expands the therapeutic possibilities with timely diagnosis of the disease.
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Sikorskaya MV, Candidate of Medical Sciences n., associate professor of caf. nervous diseases ZSMU.
Remenyuk YK, chief physician of Avatazh Medical Center.