EVALUATION OF TRAPEZIUS, MASSETER AND STERNOCLEIDOMASTOID MUSCLE THICKNESS, PAIN THRESHOLD AND DISABILITY IN PATIENTS WITH UNILATERAL CERVICAL PAIN AND RADICULOPATHY

Yıl 2022, Cilt: 29 Sayı: 4, 619 - 628, 27.12.2022

Hüseyin Alper Kızıloğlu , Veysel Atilla Ayyıldız , Hatice Yakut , Zülal Bekar

https://doi.org/10.17343/sdutfd.1180661

Öz

Objective
Chronic cervical pain is one of the most common
musculoskeletal symptoms observed worldwide. In
our study, we aimed to show the thickness changes, if
any, in the neck region and muscle groups adjacent to
the neck region in ultrasonography (USG) of patients
with unilateral chronic neck pain. We also aimed to
show the change in the pain threshold of the muscles
in pressure algometry in a separate patient group.
Material and Method
Patients with unilateral neck pain, disc herniation
on cervical magnetic resonance imaging (MRI),
radiculopathy findings proven on electromyography
(EMG), and pain for 12 weeks or longer (fitting the
definition of chronic neck pain) were included in
the study. The study was conducted prospectively.
A total of 32 patients (25 women, 7 men) were
included. Visual analog scale (VAS) test, pressure
algometer measurement and neck disability test were
used to evaluate the pain of the patients. Masseter,
sternocleidomastoid (SCM) and trapezius muscle
thicknesses of the patients were measured by US.
In addition, pain thresholds of all three muscles were
determined by pressure algometer.
Results
The mean age of the patients was 49.71 ± 11.73 years.
No statistically significant difference was observed
for the pain threshold levels of SCM, trapezius and
masseter muscles on the side with and without pain
(p = 0.645; p = 0.386; p = 0.545, respectively). No
statistically significant difference was observed for
SCM, trapezius and masseter muscle thicknesses on
the pain and non-pain side (p = 0.76; p = 0.563; p =
0.603, respectively).
Conclusion
There was no statistically significant difference
in pain thresholds for all 3 muscles (trapezius,
sternocleidomastoid muscle, and masseter muscle)
worked on the pain and non-pain side in the patient
with unilateral chronic neck pain. In the measurement
of muscle thickness by US, no statistically significant
difference was found for the side with and without
pain for all 3 muscles (trapezius, sternocleidomastoid
muscle and masseter muscle).

Anahtar Kelimeler

Cervical pain, USG, Muscle thicknesses

TEK TARAFLI SERVİKAL AĞRI VE RADİKÜLOPATİSİ OLAN HASTALARDA TRAPEZİUS, MASSETER VE STERNOKLEİDOMASTOİD KAS KALINLIKLARININ, AĞRI EŞİĞİNİN VE ÖZÜRLÜLÜĞÜN DEĞERLENDİRİLMESİ

Öz

Amaç
Kronik servikal ağrı, dünya çapında gözlenen en yaygın
kas iskelet sistemi semptomlarından biridir. Çalışmamızda
tek taraflı kronik boyun ağrısı olan olguların
ultrasonografide(USG) boyun bölgesinde ve boyun
bölgesine komşu kas gruplarında varsa kalınlık değişimlerini
göstermeyi amaçladık. Ayrıca aynı hasta
grubunun, basınç algometrede kasların ağrı eşiğindeki
değişimi göstermeyi de amaçladık.
Gereç ve Yöntem
Tek taraflı boyun ağrısı olup, servikal manyetik rezonans
görüntülemede(MRG) disk herniasyonu olan,
elektromyografide(EMG) radikülopati bulguları kanıtlanan
ve 12 hafta veya üzeri ağrısı olan (kronik boyun
ağrısı tanımına uyan) hastalar çalışmaya dahil
edilmiştir. Çalışma prospektif olarak yapılmıştır. Toplamda
32 hasta (25 kadın, 7 erkek) dahil edilmiştir.
Hastaların ağrılarını değerlendirmede vizüel analog
skala(VAS) testi, basınç algometre ile ölçüm ve boyun
özürlülük testi yapılmıştır. Hastaların masseter, sternokleidomastoid
(SKM) ve trapezius kas kalınlıkları
USG ile ölçülmüştür. Ayrıca her üç kasın ağrı eşikleri
basınç algometre ile belirlenmiştir.
Bulgular
Hastaların yaşları 20-69 arasında değişmekte olup
ortalama yaşları 49,71 ± 11,73’dur. Ağrı olan ve olmayan
tarafta SKM, trapezius ve masseter kası ağrı eşik
seviyeleri için istatistiksel anlamlı fark gözlenmemiştir
(sırası ile p = 0,645; p = 0,386; p = 0,545). Ağrı olan
ve olmayan tarafta SKM, trapezius ve masseter kas
kalınlığı için istatistiksel anlamlı fark gözlenmemiştir
(sırası ile p = 0,76; p = 0,563; p = 0,603).
Sonuç
Tek taraflı kronik boyun ağrısı olan hastada, ağrı olan
tarafta ve olmayan tarafta çalışılan her 3 kas için (trapezius,
sternokleidomastoid kas ve masseter kası)
ağrı eşiklerinde istatistiksel anlamlı fark gözlenme-
miştir. Kas kalınlıklarının USG ile ölçümünde de her 3
kas için (trapezius, sternokleidomastoid kas ve masseter
kası) ağrı olan ve olmayan taraf için istatistiksel
anlamlı fark gösterilememiştir.

Anahtar Kelimeler

Servikal ağrı, USG, Kas kalınlıkları

Kaynakça

• 1. Hogg-Johnson S, Van Der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J, et al. The burden and determinants of neck pain in the general population. European Spine Journal. 2008;17(1):39-51.
• 2. Kahlaee AH, Ghamkhar L, Arab AM. The association between neck pain and pulmonary function: a systematic review. American journal of physical medicine & rehabilitation. 2017;96(3):203-10.
• 3. Freeman MD, Woodham MA, Woodham AW. The role of the lumbar multifidus in chronic low back pain: a review. Pm&r. 2010;2(2):142-6.
• 4. Javanshir K, Rezasoltani A, Mohseni-Bandpei MA, Amiri M, Ortega-Santiago R, Fernández-De-Las-Peñas C. Ultrasound assessment of bilateral longus colli muscles in subjects with chronic bilateral neck pain. American journal of physical medicine & rehabilitation. 2011;90(4):293-301.
• 5. Fernández-De-Las-Peñas C, Albert-Sanchís JC, Buil M, Benitez JC, Alburquerque-Sendín F. Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls. journal of orthopaedic & sports physical therapy. 2008;38(4):175-80.
• 6. Radhakrishnan K, Litchy WJ, O'fallon WM, Kurland LT. Epidemiology of cervical radiculopathy: a population-based study from Rochester, Minnesota, 1976 through 1990. Brain. 1994;117(2):325-35.
• 7. Ghaly B, Ghaly S. The Use of Neuromuscular Ultrasound and NCS/EMG Testing in the Differential Diagnosis of Carpal Tunnel Syndrome and Radiculopathy. The Neurodiagnostic Journal. 2019;59(1):23-33.
• 8. Kinser AM, Sands WA, Stone MH. Reliability and validity of a pressure algometer. The Journal of Strength & Conditioning Research. 2009;23(1):312-4.
• 9. Liu W, Fan J, Bai J, Tang P, Chen J, Luo Y, et al. Magnetic resonance imaging: a possible alternative to a standing lateral radiograph for evaluating cervical sagittal alignment in patients with cervical disc herniation? Medicine. 2017;96(39).
• 10. Cagnie B, Cools A, De Loose V, Cambier D, Danneels L. Differences in isometric neck muscle strength between healthy controls and women with chronic neck pain: the use of a reliable measurement. Archives of physical medicine and rehabilitation. 2007;88(11):1441-5.
• 11. Edmondston SJ, Wallumrød ME, MacLéid F, Kvamme LS, Joebges S, Brabham GC. Reliability of isometric muscle endurance tests in subjects with postural neck pain. Journal of manipulative and physiological therapeutics. 2008;31(5):348-54.
• 12. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. Journal of manipulative and physiological therapeutics. 1991.
• 13. Fredriksson L, Alstergren P, Kopp S. Absolute and relative facial pressure-pain thresholds in healthy individuals. Journal of orofacial pain. 2000;14(2).
• 14. Chae SH, Lee SJ, Kim MS, Kim TU, Hyun JK. Cervical multifidus muscle atrophy in patients with unilateral cervical radiculopathy. J Korean Acad Rehabil Med. 2010;34(6):743-51.
• 15. Hides J, Richardson C, Jull G, Davies S. Ultrasound imaging in rehabilitation. Australian Journal of Physiotherapy. 1995;41(3):187-93.
• 16. Hides J, Stokes M, Saide M, Jull G, Cooper D. Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine. 1994;19(2):165-72.
• 17. Stokes M, Hides J, Nassiri DK. Musculoskeletal ultrasound imaging: diagnostic and treatment aid in rehabilitation. Physical Therapy Reviews. 1997;2(2):73-92.
• 18. Javanshir K, Amiri M, Mohseni-Bandpei MA, Rezasoltani A, Fernández-De-Las-Peñas C. Ultrasonography of the cervical muscles: a critical review of the literature. Journal of manipulative and physiological therapeutics. 2010;33(8):630-7.
• 19. Hides J, Gilmore C, Stanton W, Bohlscheid E. Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Manual therapy. 2008;13(1):43-9.
• 20. Rezasoltani A, Ahmadipoor A, Khademi-Kalantari K, Javanshir K. The sign of unilateral neck semispinalis capitis muscle atrophy in patients with chronic non-specific neck pain. Journal of back and musculoskeletal rehabilitation. 2012;25(1):67-72.
• 21. Woodhouse JB, McNally EG, editors. Ultrasound of skeletal muscle injury: an update. Seminars in Ultrasound, CT and MRI; 2011: Elsevier.
• 22. Falla DL, Jull GA, Hodges PW. Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine. 2004;29(19):2108-14.
• 23. Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine. 2004;29(13):1436-40.
• 24. O'leary S, Falla D, Elliott JM, Jull G. Muscle dysfunction in cervical spine pain: implications for assessment and management. journal of orthopaedic & sports physical therapy. 2009;39(5):324-33.
• 25. Schomacher J, Falla D. Function and structure of the deep cervical extensor muscles in patients with neck pain. Manual therapy. 2013;18(5):360-6.
• 26. Lee H, Nicholson LL, Adams RD. Neck muscle endurance, self-report, and range of motion data from subjects with treated and untreated neck pain. Journal of manipulative and physiological therapeutics. 2005;28(1):25-32.
• 27. Parazza S, Vanti C, O’Reilly C, Villafañe JH, Tricás Moreno JM, Estébanez De Miguel E. The relationship between cervical flexor endurance, cervical extensor endurance, VAS, and disability in subjects with neck pain. Chiropractic & manual therapies. 2014;22(1):1-7.
• 28. Ghamkhar L, Kahlaee AH. Are ultrasonographic measures of cervical flexor muscles correlated with flexion endurance in chronic neck pain and asymptomatic participants? American journal of physical medicine & rehabilitation. 2017;96(12):874-80.
• 29. Ohrbach R, Gale EN. Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myogenic pain. Pain. 1989;39(2):157-69.
• 30. Kosek E, Ekholm Ja, Nordemar R. A comparison of pressure pain thresholds in different tissues and body regions. Long-term reliability of pressure algometry in healthy volunteers. Scandinavian journal of rehabilitation medicine. 1993;25(3):117-24.