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      Prevalence of Myofascial Trigger Points in Patients with Mild to Moderate Painful Knee Osteoarthritis: A Secondary Analysis

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          Abstract

          Objective: To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between the number of MTrPs and pain and function in patients presenting knee pain osteoarthritis (OA). Methods: This was a secondary analysis of data from a cross-sectional study. The prevalence of MTrPs located in tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles was studied in 114 patients (71 men and 43 women) with knee OA. Pain and functionality were assessed with a numerical pain rating scale (NPRS), the Western Ontario, McMaster Universities Osteoarthritis Index (WOMAC) score, the Barthel Index, and the timed up and go test. Results: The prevalence of latent MTrPs was detected via palpation and was estimated to be 50%, 35%, 25%, 29%, 33%, and 12% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. The prevalence of active MTrPs was estimated to be 11%, 17%, 30%, 18%, 25%, and 17% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. Pain was measured with the NPRS scale and was poorly correlated with the prevalence of latent MTrPs (r = 0.2; p = 0.03) and active MTrPs (r = 0.23; p = 0.01) in the hamstrings. Disability was moderately correlated with the number of latent MTrPs in the tensor fasciae latae muscle (Barthel, r = 0.26; p = 0.01 and WOMAC, r = 0.19; p = 0.04). Conclusions: This secondary analysis found that the prevalence of the MTrPs varied from 11% to 50% in different muscles of patients with mild to moderate painful knee osteoarthritis. Pain was correlated poorly with the prevalence of latent and active MTrPs in the hamstring muscles, and disability correlated moderately with the number of latent MTrPs in tensor fasciae latae.

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          Sensitization in patients with painful knee osteoarthritis.

          Pain is the dominant symptom in osteoarthritis (OA) and sensitization may contribute to the pain severity. This study investigated the role of sensitization in patients with painful knee OA by measuring (1) pressure pain thresholds (PPTs); (2) spreading sensitization; (3) temporal summation to repeated pressure pain stimulation; (4) pain responses after intramuscular hypertonic saline; and (5) pressure pain modulation by heterotopic descending noxious inhibitory control (DNIC). Forty-eight patients with different degrees of knee OA and twenty-four age- and sex-matched control subjects participated. The patients were separated into strong/severe (VAS>or=6) and mild/moderate pain (VAS<6) groups. PPTs were measured from the peripatellar region, tibialis anterior (TA) and extensor carpi radialis longus muscles before, during and after DNIC. Temporal summation to pressure was measured at the most painful site in the peripatellar region and over TA. Patients with severely painful OA pain have significantly lower PPT than controls. For all locations (knee, leg, and arm) significantly negative correlations between VAS and PPT were found (more pain, more sensitization). OA patients showed a significant facilitation of temporal summation from both the knee and TA and had significantly less DNIC as compared with controls. No correlations were found between standard radiological findings and clinical/experimental pain parameters. However, patients with lesions in the lateral tibiofemoral knee compartment had higher pain ratings compared with those with intercondylar and medial lesions. This study highlights the importance of central sensitization as an important manifestation in knee OA.
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            Pain sensitization in people with knee osteoarthritis: a systematic review and meta-analysis.

            Emerging evidence suggests that pain sensitization plays an important role in pain associated with knee osteoarthritis (OA). This systematic review and meta-analysis examined the evidence for pain sensitization in people with knee OA and the relationship between pain sensitization and symptom severity.
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              Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review.

              Hyperexcitability of the central nervous system (CNS) has been suggested to play an important role in the chronic pain experienced by osteoarthritis (OA) patients. A systematic review following PRISMA guidelines was performed to evaluate the existing evidence from the literature related to the presence of central sensitization (CS) in patients with OA.Electronic databases PubMed and Web of Science were searched to identify relevant articles using pre-defined keywords regarding CS and OA. Full-text clinical reports addressing studies of CS in human adults with chronic complaints due to osteoarthritis were included and screened for methodological quality by two independent reviewers. From the 40 articles that were initially eligible for methodological quality assessment, 36 articles achieved sufficient scores and therefore were discussed. The majority of these studies were case-control studies and addressed OA of the knee joint. Different subjective and objective parameters considered manifestations of CS, which have been previously reported in other chronic pain conditions such as whiplash or rheumatoid arthritis, were established in subjects with OA pain. Overall results suggest that, although peripheral mechanisms are involved in OA pain, hypersensitivity of the CNS plays a significant role in a subgroup of subjects within this population. Although the majority of the literature provides evidence for the presence of CS in chronic OA pain, clinical identification and treatment of CS in OA is still in its infancy, and future studies with good methodological quality are necessary.
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                07 August 2020
                August 2020
                : 9
                : 8
                : 2561
                Affiliations
                [1 ]Department of Physiotherapy, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
                [2 ]Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
                [3 ]Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28943 Madrid, Spain; sofia.laguarta@ 123456urjc.es
                [4 ]La Paz Hospital Institute for Health Research, IdiPAZ, 28922 Madrid, Spain
                [5 ]Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, 28922 Madrid, Spain
                [6 ]IRCCS Fondazione Don Carlo Gnocchi, 20161 Milan, Italy; mail@ 123456villafane.it (J.H.V.); pedersini93@ 123456gmail.com (P.P.)
                [7 ]Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; cescalvo@ 123456ucm.es
                [8 ]Older-adult care center "Manuel Herranz", Pozuelo de Alarcón, 28223 Madrid, Spain; vitofisio@ 123456hotmail.com (V.O.S.); evdpozuelo.rhb@ 123456gmail.com (V.B.C.)
                [9 ]Department of Physical Therapy of Alcalá University, Alcalá de Henares, 28805 Madrid, Spain; daniel.pecos@ 123456uah.es
                Author notes
                Author information
                https://orcid.org/0000-0003-0254-6501
                https://orcid.org/0000-0002-1314-624X
                https://orcid.org/0000-0002-3239-7626
                https://orcid.org/0000-0002-6569-1311
                https://orcid.org/0000-0003-0224-1783
                https://orcid.org/0000-0001-8690-0998
                Article
                jcm-09-02561
                10.3390/jcm9082561
                7464556
                32784592
                1571870f-7cd5-429f-af20-00dd1e98aecc
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 19 June 2020
                : 04 August 2020
                Categories
                Article

                myofascial pain,knee,osteoarthritis
                myofascial pain, knee, osteoarthritis

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