To explore the clinical efficacy and safety of ultrasound-guided extracorporeal shock wave in the treatment of the neck-shoulder myofascial pain syndrome.

A total of 60 patients with neck and shoulder muscle fascia pain syndrome admitted to the outpatient department of Jiangsu Subei People's Hospital and the First Affiliated Hospital of Suzhou University from January 2017 to June 2018 were prospectively divided into treatment group and the control group according to the random number table, each group had 30 cases, the control group received infrared, transcutaneous electrical nerve stimulation, massage and other routine rehabilitation training, the treatment group had additional ultrasound guided guided shock wave treatment, 2 times a week, continuous treatment for 3 week under the basis of the control group. The McGill pain questionnaire (MQG) and the neck disability index (NDI) were used to evaluate the function of the two groups before and after the first treatment and after 3 weeks. The hardness of the neck and shoulder fascia (Emean value) and thickness (mm) were evaluated by shear wave ultrasound elastography.

The PRI-T scores of the two groups before treatment, after the first treatment, and after 3 weeks of treatment were (8.1±3.2)/(7.9±3.3), (4.3 ±2.6)/(5.2±2.5), (1.1±1.3)/(3.3±1.4) points, the difference between the two groups was statistically significant (F=2.368, F=1.985, P<0.05). There was significant difference between the groups (t=1.985, P<0.05). The VAS scores were: (6.2±2.3)/(6.4±2.4), (4.4±2.1)/(4.9±2.3), (2.6±1.3)/(3.2±1.7) points, before and after treatment, the differences between the two groups were statistically significant (F=2.315, F=1.876, P<0.05). The difference between the groups was statistically significant (t=1.752, P<0.05). The PPI scores were (2.6±0.8)/(2.5±0.7), (1.3±0.6)/(1.6±0.4), (0.4±0.3)/(0.9±0.6) points. The difference before and after treatment between the two groups was statistically significant (F=2.056, F=1.988, P<0.05), and the intergroup difference was statistically significant (t=1.680, P<0.05). The NDI were (43.2±2.9)/(42.9±2.8), (26.7±3.4)/(31.1±3.3), (11.4±3.2)/(23.3±3.4) points, and the differences before and after treatment between the two groups were statistical significance (F=3.689, F=3.002, P<0.05), the intergroup comparison was statistically significant (t=1.680, P<0.05). After 3 weeks of the treatment, the hardness and thickness of the trapezius fascia were improved from (18.4±4.3)/(17.9±4.4) kPa and (7.9±0.8)/(7.8±0.8) mm before treatment to (6.5±2.8)/(9.7±3.2) kPa and (4.6±0.5)/(5.4±0.7) mm, the difference was statistically significant (t=6.325, t=5.256, t=2.589, t=2.014, P< 0.05), and the treatment group were better than the control group, difference was statistically significant (t=2.652, t=1.801, P<0.05). The hardness and thickness of the levator fascia of the two groups were improved, from (14.7±3.4)/(14.9±3.1) kPa and (6.7±0.6)/(6.8±0.5) mm before treatment to (5.9±2.4)/(8.1±3.7) kPa and (4.8±0.6)/(5.1±0.6) mm, the difference were statistically significant (t=4.585, t=3.652, t=1.982, t=1.710, P<0.05). The treatment group were better than the control group, and the difference was statistically significant (t=2.655, t=1.699, P<0.05). The hardness and thickness of the rhomboid fascia of the two groups were improved, from (10.3±4.2)/(11.1±3.8) kPa and (6.0±0.7)/(6.4±0.6) mm to (4.2±1.3)/(6.4±2.8) kPa and (4.7±0.3)/(5.6±0.6) mm, the difference were statistically significant (t=4.602, t=4.055, t=2.621, t=1.986, P<0.05), and the treatment group were better than the control group, difference was statistically significant (t=2.540, t=1.729, P<0.05).

Ultrasound-guided extracorporeal shock wave can effectively relieve the pain of neck-shoulder myofascial pain syndrome, improve the function of neck and the shoulder. Meanwhile, the application of shear-wave ultrasonic elastography can provide accurate diagnosis and treatment, which is worthy of clinical application.

Myofascial pain syndromes; Extracorporeal shockwave therapy; Trigger points; Musculoskeletal ultrasound