Fibromiyalji'de kuru iğnelemenin tetik noktalar üzerine akut etkisinin shear wave elastografi ile değerlendirilmesi
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Tarih
2021
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Yayıncı
Hatay Mustafa Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Fibromiyalji (FM) yaygın ağrı ve tetik noktalarla karakterize romatizmal bir hastalıktır. Tetik nokta (TN) ile ilişkili ağrılar, tüm ağrıların %21-30'luk kısmını oluşturmaktadır. TN tanı ve tedavi etkinliğinin belirlenmesinde palpasyona ek olarak objektif ölçütlere ihtiyaç duyulmaktadır. TN inaktivasyonu ve ağrı kontrolünde kuru iğneleme (Kİ) tercih edilen tedavi modalitelerdendir. Çalışmamızın amacı; FM hastalarında m. trapezius üzerindeki tetik noktaların kas sertliklerinin ve kalınlıklarının shear wave elastografi (SWE) yöntemiyle ölçmek ve belirlenen noktalara uygulanan kuru iğnelemenin akut etkinliğini araştırmaktır. Çalışmamızda bireylerin demografik bilgileri, Vizüel Analog Skalası'yla (VAS) ağrı şiddetleri, Fibromiyalji Etki Anketi'yle (FEA) fiziksel fonksiyonları, Nottingham Sağlık Profili'yle (NSP) yaşam kaliteleri ve Hastane Anksiyete ve Depresyon Ölçeği'yle anksiyete depresyon riskleri değerlendirildi. Sağ ve sol m. trapezius'un superior parçasındaki TN'ler belirlendi. TN'ler ve çevresindeki ağrısız/normal dokuların kas sertliği ve kalınlığı SWE ile ölçüldü. Bu noktalara 0,25*25mm akupunktur iğneleri ile Kİ uygulandı. İğneleme sonrası TN SWE ölçümü tekrarlandı. Tüm ölçümler 3'er kez yapılarak ortalaması kullanıldı. Katılımcıların fonksiyonel etkilenimi orta dereceydi (FEA:65.21). Katılımcılar en sık enerji, ağrı ve uyku problemlerinden yakınırken; özellikle ev hayatlarının FM'den olumsuz etkilendiği görüldü. Anksiyete risklerinin (9.83±5.27) depresyona (7.76±4.89) kıyasla daha yüksek olduğu saptandı. Sağ ve sol TN'lerin kas sertliğinin ve kalınlığının normal dokudan fazla olduğu belirlendi (p<0.001). Sağ taraf TN kas sertliği için eşik değer 40.72 (sensivite %83.02; spesifite %84.91), sol taraf için ise 43.1 (sensivite %85.19; spesifite %88.68) olarak tespit edildi. TN'lere uygulanan kuru iğneleme sonrası kasın sertliği ve kalınlığında anlamlı bir azalma oldu (p<0.001). Ayrıca sağ m. trapezius kas sertliğiyle yaş arasında orta düzeyde korelasyon kaydedildi. Sonuç olarak, FM hastalarında tanı kriterleri arasında yer alan tetik noktalardaki kas sertliği ve kalınlığının normalden fazla olduğu bulundu ve bu noktalar için eşik değer tespit edildi. Bu değerlerin tanı ve tedavinin etkinliğinin belirlenmesinde önemli katkılar sağlayacağı kanaatindeyiz. Ayrıca bu noktalara uygulanan kuru iğnelemenin kas sertliği ve kalınlığını azaltmada etkin bir tedavi olduğu tespit edildi.
Fibromyalgia (FM) is a characteristic rheumatic disease with widespread pain, and trigger point (TrP) accounts for 21-30% of all pain. In addition to palpation, objective criteria are needed for the diagnosis and to determine the treatment efficacy of TrPs. Dry needling (DN) is one of the preferred treatment modalities for the inactivation of these points and pain control. The aim of this study is to determine the muscle stiffness and thickness of TrPs via Shear Wave Elastography (SWE) method and to investigate the acute effect of DN on these points in FM. Demographic data of patients were recorded, then repspectively Visual Analogue Scale, Fibromyalgia Impact Questionnaire (FIQ), Nottingham Health Profile (NHP), Hospital Anxiety Depression Scale (HADS) were used to evaluate pain, physical function, quality of life and anxiety-depression risks of the individuals. TrPs were determined in the upper trapezius muscle. Muscle stiffness and thickness of both these TrPs and surrounding painless/normal tissues were measured via SWE. DN was applied to these TrPs with 0,25*25mm acupuncture needles. SWE measurement was repeated after DN. All measurements were maden three times, and the average scores were used. The functional capacity of participants was moderate (FIQ:65.21). While they complained most frequently about energy, pain, sleep problems, and their home life was adversely affected. Anxiety risks (9.83±5.27) were found higher than depression (7.76±4.89). The muscle stiffness and thickness of the right and left TrPs were higher than the normal tissue (p<0.001). The cut-off point for TrP muscle stiffness was 40.72 (sensitivity 83.02%; specificity 84.91%) on the right side, and 43.1 (sensitivity 85.19%; specificity 88.68%) on the left side. There was a significant decrease in muscle stiffness and thickness after DN of TrPs (p<0.001). In addition, a moderate correlation was recorded between right trapezius muscle stiffness and age. Consequently, it was found that the muscle stiffness and thickness of TrP, among the diagnostic criteria in FM, was higher than usual, and the cut-off point of TrP was determined. We consider that these values will make important contributions to diagnosing and to determining the effectiveness of the treatment. In addition, DN was found as an effective treatment in reducing muscle stiffness and thickness.
Fibromyalgia (FM) is a characteristic rheumatic disease with widespread pain, and trigger point (TrP) accounts for 21-30% of all pain. In addition to palpation, objective criteria are needed for the diagnosis and to determine the treatment efficacy of TrPs. Dry needling (DN) is one of the preferred treatment modalities for the inactivation of these points and pain control. The aim of this study is to determine the muscle stiffness and thickness of TrPs via Shear Wave Elastography (SWE) method and to investigate the acute effect of DN on these points in FM. Demographic data of patients were recorded, then repspectively Visual Analogue Scale, Fibromyalgia Impact Questionnaire (FIQ), Nottingham Health Profile (NHP), Hospital Anxiety Depression Scale (HADS) were used to evaluate pain, physical function, quality of life and anxiety-depression risks of the individuals. TrPs were determined in the upper trapezius muscle. Muscle stiffness and thickness of both these TrPs and surrounding painless/normal tissues were measured via SWE. DN was applied to these TrPs with 0,25*25mm acupuncture needles. SWE measurement was repeated after DN. All measurements were maden three times, and the average scores were used. The functional capacity of participants was moderate (FIQ:65.21). While they complained most frequently about energy, pain, sleep problems, and their home life was adversely affected. Anxiety risks (9.83±5.27) were found higher than depression (7.76±4.89). The muscle stiffness and thickness of the right and left TrPs were higher than the normal tissue (p<0.001). The cut-off point for TrP muscle stiffness was 40.72 (sensitivity 83.02%; specificity 84.91%) on the right side, and 43.1 (sensitivity 85.19%; specificity 88.68%) on the left side. There was a significant decrease in muscle stiffness and thickness after DN of TrPs (p<0.001). In addition, a moderate correlation was recorded between right trapezius muscle stiffness and age. Consequently, it was found that the muscle stiffness and thickness of TrP, among the diagnostic criteria in FM, was higher than usual, and the cut-off point of TrP was determined. We consider that these values will make important contributions to diagnosing and to determining the effectiveness of the treatment. In addition, DN was found as an effective treatment in reducing muscle stiffness and thickness.
Açıklama
Anahtar Kelimeler
Fizyoterapi ve Rehabilitasyon, Physiotherapy and Rehabilitation
