Authors: Isil Fazilet Kartaloglu and Aylin Altan Kus

Published in: Journal of the College of Physicians and Surgeons Pakistan, 2023

This study was conducted to determine whether radial extracorporeal shock wave therapy (rESWT) is effective on treatment-resistant myofascial trigger points (MTrPs) in the upper trapezius.

The study enrolled forty-one patients who had neck or arm/shoulder pain and confirmed MTrPs. MTrPs were considered treatment-resistant as patients had previously received conventional treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxers, dry needling, and local anesthetic injections.

All patients in the study received rESWT once per week until their pain score on the Visual Analog Scale (VAS) was less than 2 with a maximum of 5 treatment sessions. Patients were instructed not to take NSAIDs or do exercise therapy.

rESWT was delivered at 8 Hz, 1.5 bar with 1000 pulses targeting the MTrPs and 500 pulsestargeting the surrounding taut band. Outcome measures for the study included theVAS, Neck Disability Index (NDI), and shear wave elastography (SWE) which uses ultrasound imaging to evaluate the hardness of muscle tissue. All outcome measures were assessed at baseline and after treatment completion. The VAS score was also collected at 3-month follow-up.

• PainThe average VAS score significantly decreased by 71% between baseline and post-treatment. The VAS score continued to trend down at the 3-month follow-up.
• FunctionThe patients had significantly improved function after rESWT with average NDI scores decreasing by 81%.
• Muscle HardnessSWE demonstrated a significant decrease in muscle tissue hardness after rESWT.

• The study concluded that rESWT is a safe non-invasive treatment option to reduce pain, improve function, and decrease tissue hardness in treatment-resistant MTrPs.
• rESWT decreased pain by 71% in 5 or less treatment sessions without using exercises or other interventions.
• rESWT gave patients relief when other conventional treatments had failed.

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