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

  • Mohamed Elbarbary
    Affiliations
    Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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  • Michael Goldberg
    Affiliations
    Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada

    Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada

    Advanced Training Program in Orofacial Pain, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada

    Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Howard C. Tenenbaum
    Affiliations
    Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada

    Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada

    Advanced Training Program in Orofacial Pain, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • David K. Lam
    Affiliations
    Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, California
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  • Bruce V. Freeman
    Affiliations
    Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada

    Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada

    Advanced Training Program in Orofacial Pain, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • David J. Pustaka
    Affiliations
    Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada

    Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada

    Advanced Training Program in Orofacial Pain, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • David Mock
    Affiliations
    Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada

    Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada

    Advanced Training Program in Orofacial Pain, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada

    Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Joseph Beyene
    Affiliations
    Department of Clinical Epidemiology and Biostatistics, McMaster, Hamilton, Ontario, Canada
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  • Amir Azarpazhooh
    Correspondence
    Address requests for reprints to Dr Amir Azarpazhooh, Faculty of Dentistry, University of Toronto, 455-124 Edward Street, Toronto, ON M5G1G6, Canada.
    Affiliations
    Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada

    Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada

    Advanced Training Program in Orofacial Pain, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
    Search for articles by this author
Published:November 28, 2022DOI:https://doi.org/10.1016/j.joen.2022.11.013

      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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