Abstract
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 κ and the interclass
correlation coefficient [ICC]) as applicable.
Results
Ultrasonography located MTrPs as 2.1 ± 1.3 mm2 hypoechoic nodules at a depth of 7 ± 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 (κ = −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.
Key Words
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Article info
Publication history
Published online: November 28, 2022
Identification
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© 2022 American Association of Endodontists.
