Objective: The aim was to assess efficacy of whole body neuromuscular ultrasound to evaluate posture and targeted management of muscle spasticity and pain.

Background: Muscle spasticity and restricted movement is pillar mechanics for pain and postural imbalance. Dry needling (DN) of myofascial trigger points (MTrP) under ultrasound (US) guidance is a prioritized method for treatment myofascial pain [1], restoring posture [2] and spasticity [3].

Method: We included 50 patients (32 females, aged 19–65 y.o.) with muscle pain, altered posture. Healthy 20 individuals (aged 18–52 y.o.) were controls. All patients underwent general exam, MRI, precise physical tests, extensive functional multiparameter neuromuscular US using 4-8 MHz /5-12 MHz probes in shoulder, sacroiliac joint (SIJ), intervetrebral spaces, foot, ankle, gluteus region and pelvis, abdominal wall, diaphragm and pelvic floor motility. We did M-mode, transient elastography and shear wave elastography (SWE) of nerves and muscles, evaluated structure, CSA, detecting compressions, contact to scars, muscle TrPs, spasticity and evaluated nerve motion and SWE during overstraining neurodynamic tests. Then patients received DN of detected MTrP under US guidance.

Results: We detected different patterns of decreasing motility, contractility (muscle contracted/rested thickness) on M-mode during functional tests and walking in all levels in group 1 (p<0.05); local areas of spasticity (trigger points) were successfully detected on shoulder rotator mudcles, distal/proximal leg, pelvis and spine for precise guidance of deep DN. After DN of detected MTrP the signs of inactivation trigger points, motion recovery in all areas were recognized including total recovery of shoulder impingement after DN in 45 cases. US demonstrated improvement muscle structure, increasing motility, contractility. Pain relief in groups 1 VAS scores changed from 7.4 to 2.3 (p <0.05) and remained 24 hours after in all cases. Muscles SWE was 3.1 ±0.3 kPa vs 4.8±.7 kPa in spastic area and decreased to 3.4 ±0.4 kPa after treatment. US imaging of nerves demonstrated improvement of neuropathy signs as decrease of fascicles diameter from 1.8 to 0.9 mm, SWE and nerve motion changes were insignificant during tests.

Conclusion: Extensive dynamic neuromuscular US is feasible and informative protocol for patient with pain, spacticity and allow performing targeted intervention.

References: 1. Bubnov R, Kalika L, Babenko L. AB1199 Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine. Annals of the Rheumatic Diseases 2018;77:1699. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3949 2. Bubnov RV. Evidence-based pain management: is the concept of integrative medicine applicable? EPMA J 2012, 3(1):13. 3. Bubnov RV: Ultrasonography for local muscle spasticity management. Mov Disord 2012, 27(Suppl 1):336.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/whole-body-neuromuscular-ultrasound-for-evaluating-posture-and-targeted-management-of-muscle-spasticity-and-pain/