Assessment of Concordance between Chairside Ultrasonography and Digital Palpation in Detecting Myofascial Trigger Points in Masticatory Myofascial Pain Syndrome

Introduction: Masticatory myofascial pain is a musculoligamentous syndrome that can mimic odontogenic pain. Pain referral to odontogenic structures can be traced to hyperirritated myofascial trigger points (MTrPs). This pragmatic study evaluated the concordance between ultrasonography and palpation in detecting MTrPs in the masseter and temporalis muscles. Methods: Fifty-seven patients suspected to have temporomandibular disorder were included. MTrPs were palpated manually by expert clinicians. Ultrasonography was then performed by a blind sonographer. The quantity of MTrPs and the involved muscle sections, the pain occurrence, and the location of the MTrPs within the muscle sections were compared using the mean difference (MD) and concordance statistics (Cohen K and the interclass correlation coefficient [ICC]) as applicable. Results: Ultrasonography located MTrPs as 2.1 & PLUSMN; 1.3 mm2 hypoechoic nodules at a depth of 7 & PLUSMN; 3.3 mm. Ultrasonography moderately agreed with palpation on the quantity of MTrPs per patient (MD = 1; 95% confidence interval [CI], 0.06-1.9; ICC = 0.56; 95% CI, 0.32-0.72). Palpation detected marginally more involved muscle sections per patient (MD = 0.7; 95% CI, 0.06-1.34.05; ICC = 0.64; 95% CI, 0.44-0.77) with more pain occurrence per patient (MD = 1.4; 95% CI, 0.56-2.28; ICC = 0.13; 95% CI,-0.26 to 0.41). There was a discordance in the location of the MTrPs within the muscle sections per patient (K =-0.46; 95% CI,-0.77 to-0.14). Conclusions: Ultrasonography and palpation concurred moderately to substantially on the quantity of MTrPs and the involved muscle sections but disagreed on the location of the MTrPs within the muscle sections. Ultrasonography has the potential as a chairside diagnostic aid to help clinicians determine an accurate diagnosis, enhance patient experience during examination, and avoid unnecessary treatments that can mitigate the risk of iatrogenic damage. (J Endod 2023;49:129-136.)

Automated summary

This study evaluated the concordance between ultrasonography and palpation in detecting myofascial trigger points (MTrPs) in patients with masticatory myofascial pain. The results showed moderate to substantial agreement between ultrasonography and palpation regarding the quantity of MTrPs and the involved muscle sections, but disagreement on the location of MTrPs within the muscle sections. Ultrasonography has the potential to serve as a chairside diagnostic aid for accurate diagnosis and improved patient experience.