PICO
Patient/Population
Patients, aged 20 to 25 years, suffering from myofascial trigger points (MTrPs) in the upper trapezius muscle (UTM). (n=60)
Intervention
- Intramuscular injections lidocain + exercise
Comparison
- Extracorporeal shock wave therapy (rESWT) + exercise
Outcomes
Pain severity
Muscle elasticity
Pressure pain threshold
Neck disability
Translatability: (3/3) Easy 
Comments: rESWT in patients with MTrPs in the UTM is safe and leads to reduced pain and improved muscle elasticity, pressure pain threshold, and neck disability index, without adverse effects. Clinicians should consider rESWT instead of injections of lidocaine in the treatment of MTrPs in the UTM.
Limitations: Patients were not blinded to the therapy. There were no subgroups with variable rESWT intensities, intervals, or frequencies because total energy is dose-dependent. This study was not a non-inferiority trial. Accordingly, it could not establish that rESWT is as effective as lidocaine injections in the treatment of MTrPs of the UTM. This study’s target demographic was individuals aged 20 to 25 years, avoiding MPS in combination with degenerative joint issues, which is typical in the elderly.
Appraisals:
Trustworthiness – The study contains no serious weaknesses. Based on this result you should conclude that the trustworthiness of the study is high (90%). This means there is a 10% chance that alternative explanations for the effect found are possible. The effect size was not reported and no CI was reported. (by CAT)
BTB
Intervention – 1
- Lidocaine
Dose
- 2 mL of 1% lidocaine.
Periodicity
- Three injections, one injection per week.
Local/Technic:
Intramuscular injections at the site of the MTrP using a 25 Gauge needle. A local twitch reaction when the trigger site was injected confirmed the MTrP.
Intervention – 2
- rESWT
Dose
- 2000 shock waves per session. Air pressure of 2.5 bar, resulting in a positive energy flux density of 0.1 mJ/mm2. Frequency, 12 Hz.
Periodicity
- Three sessions, one treatment session per week.
Local/Technic:
Handpiece of 15-mm convex applicator.
Intervention – 3
- UTM stretching
Dose
- 10 sessions.
Periodicity
- Twice a day.
Local/Technic:
Ppatients were taught a simple home exercise routine of UTM stretching during the first visit. The patients received a video file of the UTM stretching exercise on their mobile phones.
Citation: Suputtitada, A., Chen, C. R., Ngamrungsiri, N., & Schmitz, C. (2022). Effects of repeated injection of 1% lidocaine vs. radial extracorporeal shock wave therapy for treating myofascial trigger points: a randomized controlled trial. Medicina, 58(4), 479. https://doi.org/10.3390/medicina58040479