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Hung CY, Wang B, Chang HC, Wu WT, Liu PT, Chang KV, Su DCJ, Mezian K, Ricci V, Özçakar L. Pictorial Essay on Ultrasound and Magnetic Resonance Imaging of Paraspinal Muscles for Myofascial Pain Syndrome. Life (Basel) 2024; 14:499. [PMID: 38672769 PMCID: PMC11051048 DOI: 10.3390/life14040499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger points are common during clinical practice. Ultrasonography is the most convenient imaging tool for evaluating these muscles due to its advantages, such as providing good delineation of soft tissues, easy accessibility, and zero radiation. Additionally, ultrasound can serve as a useful guiding tool for paraspinal muscle intervention to prevent inadvertent injuries to vital axial neurovascular structures. This pictorial essay presents ultrasound scanning protocols for the paraspinal and other associated muscles as well as a discussion of their clinical relevance. Axial magnetic resonance imaging has also been used to elucidate reciprocal anatomy. In conclusion, ultrasound imaging proves to be a valuable tool that facilitates the differentiation of individual paraspinal muscles. This capability significantly enhances the precision of interventions designed to address myofascial pain syndrome.
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Affiliation(s)
- Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan;
| | - Hsiang-Chi Chang
- Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, Taipei 24213, Taiwan;
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
| | | | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (C.-Y.H.); (W.-T.W.)
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 10048, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
| | - Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan 71004, Taiwan;
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, 12800 Prague, Czech Republic;
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Department of Biomedical and Neuromotor Science, Istituto di Ricovero e Cura a Carattere Scientifico Rizzoli Orthopedic Institute, 40136 Bologna, Italy;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
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Jacob J, O'Connor P, Pass B. Muscle Injury Around the Shoulder. Semin Musculoskelet Radiol 2022; 26:535-545. [DOI: 10.1055/s-0042-1756687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractAcute shoulder tendon and intra-articular injuries are common and their imaging well described. However, a subset of patients present with more unusual acute shoulder muscle injury. Of these, pectoralis major muscle injuries are encountered the most often and are increasingly prevalent due to a focus on personal fitness, particularly bench-press exercises. Other muscle injuries around the shoulder are rare. This article reviews the anatomy, mechanism of injury, and the imaging findings in relation to injuries of these muscles around the shoulder. We focus on pectoralis major injury but also review proximal triceps, latissimus dorsi, teres major, and deltoid muscle injuries, providing imaging examples.
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Affiliation(s)
- J. Jacob
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - P. O'Connor
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - B. Pass
- Chapel Allerton Hospital, Leeds Teaching Hospitals Trust, Leeds, United Kingdom
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Xue H, Bird S, Jiang L, Jiang J, Cui L. Anchoring Apparatus of Long Head of the Biceps Tendon: Ultrasonographic Anatomy and Pathologic Conditions. Diagnostics (Basel) 2022; 12:diagnostics12030659. [PMID: 35328211 PMCID: PMC8947553 DOI: 10.3390/diagnostics12030659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 02/01/2023] Open
Abstract
The long head of the biceps tendon (LHBT) has been recognized as an important generator of anterior shoulder pain, causing a significant reduction in the shoulder flexion range. Various tendinous and ligamentous structures form the anchoring apparatus of the LHBT along its course to maintain its appropriate location during shoulder movements, including the coracohumeral ligament (CHL), superior glenohumeral ligament (SGHL), subscapularis (SSC) tendon and supraspinatus (SSP) tendon as well as the less recognized tendons of pectoralis major (PM), latissimus dorsi (LD) and teres major (TM). Lesions of this stabilizing apparatus may lead to an instability of the LHBT, resulting in pain at the anterior shoulder. Ultrasonography (US) has been increasingly used in the assessment of shoulder injuries, including the anchoring apparatus of the LHBT. An accurate diagnosis of these injuries is often challenging, given the complex anatomy and wide spectrum of pathologies. In this review article, US anatomy and common pathologic conditions that affect the anchoring apparatus of the LHBT are discussed, including biceps pulley lesions, adhesive capsulitis, chronic pathology of SSC and SSP tendons, tears in the PM tendon and injuries to the LD and TM. Knowledge of a normal anatomy, an appropriate scanning technique and US findings of common pathologic conditions are the keys to accurate diagnoses.
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Affiliation(s)
- Heng Xue
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China; (H.X.); (L.J.); (J.J.)
| | | | - Ling Jiang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China; (H.X.); (L.J.); (J.J.)
| | - Jie Jiang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China; (H.X.); (L.J.); (J.J.)
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China; (H.X.); (L.J.); (J.J.)
- Correspondence: ; Tel.: +86-15611908349
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Serven V, Kopec K. Man with sharp pain in left upper back. J Am Coll Emerg Physicians Open 2021; 2:e12369. [PMID: 33532759 PMCID: PMC7831617 DOI: 10.1002/emp2.12369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Victoria Serven
- Department of Emergency MedicineCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Kathryn Kopec
- Department of Emergency MedicineCarolinas Medical CenterCharlotteNorth CarolinaUSA
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Abstract
Isolated injury to the latissimus dorsi is rare. Partial tendon tears may be successfully treated nonsurgically. Complete tendon ruptures require surgical repair. Tendon repair can be approached either through an anterior deltopectoral incision with a secondary small posterior axillary incision or through a long posterior axillary incision. Suture anchors can be used to repair the latissimus dorsi to the humeral attachment. Although the literature is limited to single-patient case series, most patients have returned to full athletic activity after surgical repair.
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Meijer KA, Andrews JR. Latissimus and Pectoralis Tendon Injuries in the Overhead Athlete: Evaluation and Management. OPER TECHN SPORT MED 2016. [DOI: 10.1053/j.otsm.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Friedman MV, Stensby JD, Hillen TJ, Demertzis JL, Keener JD. Traumatic Tear of the Latissimus Dorsi Myotendinous Junction: Case Report of a CrossFit-Related Injury. Sports Health 2015; 7:548-52. [PMID: 26502450 PMCID: PMC4622375 DOI: 10.1177/1941738115595975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a “muscle up.” Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level.
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Affiliation(s)
- Michael V Friedman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - J Derek Stensby
- Mallinckrodt Institute of Radiology, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Travis J Hillen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Jennifer L Demertzis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
| | - Jay D Keener
- Department of Orthopedic Surgery, Washington University School of Medicine and Barnes-Jewish Hospital, St. Louis, Missouri
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