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Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up

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Abstract

Objective

A definitive diagnosis of chronic neck pain (CNP) is sometimes not possible. The aim of this study was to understand the possible role of the deep fasciae in CNP and the utility of the ultrasonography in the diagnosis of myofascial neck pain.

Methods

The morphometric and clinical data of 25 healthy subjects and 28 patients with CNP were compared. For all subjects, the active and passive cervical range of motion (ROM) was analyzed and the neck pain disability questionnaire (NDPQ) was administered. The fascial thickness of the sternal ending of the sternocleidomastoid and medial scalene muscles was also analyzed by ultrasonography.

Results

There were significant differences between healthy subjects and patients with CNP in the thickness of the upper side of the sternocleidomastoid fascia and the lower and upper sides of the right scalene fascia both at the end of treatment as during follow-up. A significant decrease in pain and thickness of the fasciae were found. Analysis of the thickness of the sub-layers showed a significant decrease in loose connective tissue, both at the end of treatment and during follow-up.

Conclusions

The data support the hypothesis that the loose connective tissue inside the fasciae may plays a significant role in the pathogenesis of CNP. In particular, the value of 0.15 cm of the SCM fascia was considered as a cut-off value which allows the clinician to make a diagnosis of myofascial disease in a subject with CNP. The variation of thickness of the fascia correlated with the increase in quantity of the loose connective tissue but not with dense connective tissue.

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Abbreviations

ROM:

Range of motion

SCM:

Sternocleidomastoid muscle

CC:

Center of coordination

HA:

Hyaluronic acid, hyaluronan

NPDQ:

Neck Pain Disability Questionnaire

LCT:

Loose connective tissue

MRI:

Magnetic resonance imaging

VAS:

Visual analogical scale

MEL:

Massage electrotherapy Laser

FM:

Fascial manipulation

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Acknowledgments

We would like to thank the whole Operative Unit of Rehabilitation, of Padova University. Special thanks go to all the physiotherapists who made the research possible.

Conflict of interest

The authors declare that they have no conflict of interest. The Department of Physical Medicine and Rehabilitation provided all equipment for the project. There are no financial benefits to the authors.

Ethical standard

This clinical trial was performed in accordance with ethical standards on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983. The investigation and use of patient data for research purposes were in accordance with the Declaration of the World Medical Association. Written informed consent was obtained as required. The studies follow Good Clinical Practice. Ethics statement was not needed because it was used non-invasive conventional treatments. Patients were informed about every single treatment modality and the modes of evaluation.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Padova, Padua, Italy

    Antonio Stecco

  2. Department of Physical and Rehabilitation Medicine, University of Padova, Padua, Italy

    Andrea Meneghini

  3. Department of Basic Biomedical Sciences, Touro/Harlem College of Osteopathic Medicine, New York, NY, USA

    Robert Stern

  4. Department of Molecular Medicine, University of Padova, Via Gabelli 65, 35127, Padua, Italy

    Carla Stecco

  5. Institute of Physical and Rehabilitation Medicine, University of São Paulo, São Paulo, Brazil

    Marta Imamura

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  1. Antonio Stecco
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  2. Andrea Meneghini
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Corresponding author

Correspondence to Carla Stecco.

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Stecco, A., Meneghini, A., Stern, R. et al. Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up. Surg Radiol Anat 36, 243–253 (2014). https://doi.org/10.1007/s00276-013-1185-2

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  • DOI: https://doi.org/10.1007/s00276-013-1185-2

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