LAUSR

Muscles and fascia are the major source of pain in rheumatic diseases. Dry needling under ultrasound guidance (DN-US) is a crucial therapeutic approach to treat muscle pain [1,2], the definition `myo-fascial` calls for searching trigger points (TrPs) in fascia to improve the treatment effectiveness.Aim was to evaluate the relevance of fascial ultrasound for DN-US in myo-fascial pain.We included 36 patients (21 females, 20-69 years old) with myofascial pain different localisations (low back, limbs, shoulder, neck pain), postural imbalance; did DN-US protocol according to R. Bubnov [1]: trigger points were identified according, fine (28G) steel needle DN-US was applied. Additionally considered fascial structures for detecting areas of abnormalities (hypervascularity, heterogeinity, hypomotility, adhesions) aka `trigger points` and potental nerve compression/irritation and did precise DN-US where appropriate.In all patients movement restored and pain decreaed after muscles DN; in 30 patients additionally we detected and did successful DN-US the major fascial points as follows: thoracolumbar fascia, sacroiliac joint, pelvis ligaments, rotator cuff; potential nerve compressions (e.g., arcade of Frochse, soleus arcade); nerve sheath surrounding nerves (sciatic nerve, brachial plexus) and vessels (thoracic outlet syndrome), smaller fascia, joint capsule thickening. We detected higher rates of motility, improvement postural balance and pain decrease, fewer sessions needed in patients after extensive protocol.Fascia dry needling is accessible and effective method for myo-fascial pain treatment, may provide additional mechanical benefit and help to maintain treatment effect. Affected fascia can be considered as relevant trigger points, specific ultrasound symptoms should be validated.[1]Bubnov R Trigger Points Dry Needling Under Ultrasound Guidance for Low Back Pain Therapy. Comparative Study. Annals of the Rheumatic Diseases2015;74:624. http://dx.doi.org/10.1136/annrheumdis-2015-eular.2323[2]Bubnov R, Kalika L, Babenko L. Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine. Annals of the Rheumatic Diseases 2018;77:1699. http://dx.doi.org/10.1136/annrheumdis-2018-eular.3949None declared