PDF herunterladen
Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2014; 24(03): 117-124
DOI: 10.1055/s-0034-1370952
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Die nicht invasive Untersuchung faszialer Strukturen – Eine narrative Übersichtsarbeit

Non-invasive Screening of Fascial Tissues – A Narrative Review
J. Wilke
1   Department of Sports Sciences, Goethe University Frankfurt, Frankfurt
,
W. Banzer
1   Department of Sports Sciences, Goethe University Frankfurt, Frankfurt
› Institutsangaben
Weitere Informationen

Publikationsverlauf

eingereicht: 06. November 2013

angenommen: 11. Februar 2014

Publikationsdatum:
26. Juni 2014 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Fragestellung:

Die Behandlung von Faszien hat in den vergangenen Jahren aufgrund neuer histologischer Erkenntnisse an Bedeutung gewonnen. Das Ziel dieser Übersichtsarbeit ist, die im Rahmen faszienorientierter Therapien einsetzbaren Untersuchungsinstrumente vorzustellen und hinsichtlich ihrer Testgüte zu beurteilen.

Material:

Die Datenbanken PubMed, ScienceDirect und Google Scholar wurden nach Publika­tionen durchsucht, die die Untersuchung oder Therapie faszialer Strukturen thematisieren. Für die im Rahmen dieser Studien eingesetzten Testverfahren wurden in einem zweiten Schritt Untersuchungen zur Reliabilität und Validität identifiziert.

Ergebnisse:

Zur Verlaufskontrolle von faszialen Behandlungen kommen neben funktionsorientierten Verfahren wie der Schmerzerfassung mittels Skalen insbesondere die Palpation, die Algometrie, die Myotonometrie, die Sonografie sowie die Sono-Elastografie zum Einsatz. Obwohl Skalen und algometrische Messungen eine hohe Reliabilität aufweisen, liefern sie unspezifische und subjektiv beeinflusste Resultate. Auch die Myotonometrie misst einen Komplex verschiedener Gewebe und lässt keine spezifischen Aussagen über Faszien zu. Deren isolierte Beurteilung ermöglichen das Ultraschall sowie die Sono-Elastografie. Nur bei letzterer lassen sich die Ergebnisse quantifizieren.

Diskussion:

Das Hauptproblem der meisten Verfahren liegt in der fehlenden Spezifität im Sinne der isolierten Untersuchung von Faszien. Mit der Sono-Elastografie existiert ein vielversprechendes Diagnostikum, das aber durch hohe Anschaffungskosten und Probleme bei der Standardisierung von Messungen nicht in jedem Setting einsetzbar ist.

Schlussfolgerung:

Die Entwicklung und Validierung von Verfahren zur Untersuchung faszialer Strukturen besitzt unverändert eine hohe Relevanz.

Abstract

Purpose:

Treatments of fascial tissues have gain­ed in importance due to recent histological find­ings. Thus, a considerable demand for diagnostic tools has risen. This review aims to present the instruments most frequently employed for evaluating the efficacy of fascial treatments.

Methods:

PubMed, ScienceDirect and Google Scholar were searched for publications on screen­ing or treatment of fascial tissues. Subsequently studies evaluating reliability and validity of the instruments employed in the studies of the first literature research were targeted.

Results:

To assess the success of interventions directed to fascia, pain scores, algometry, myotonometry, sonography and sono-elastography are utilized. Although both scores and algometry provide reliable measures, the results are tissue-unspecific and dependent on the subject’s impression. Likewise, myotonometry investigates a complex of different tissues. Sonography and sono-elastography do allow an isolated view on fascia. However, only the latter enables the examiner to quantify results.

Discussion:

A lack of specifity in providing information solely about fascia represents the main problem of the diagnostic instruments. Sono-Elastography is a promising method, but not applicable in each setting due to high acquisition costs and lack of standardization in measurements.

Conclusions:

Development and validation of screening tools for fascia continue to retain high relevance.

Schlüsselwörter

Faszien - Osteopathie - Messverfahren - Bindegewebe - Behandlung - Bewegungssystem

Key words

fascia - osteopathic medicine - screening tools - connective tissue - treatment - soft tissue
 

  • Literatur

  • 1 Aguilera FJ, Martín DP, Masanet RA et al. Immediate effect of ultrasound and ischemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects. A randomized controlled study. J Manipulative Physiol Ther 2009; 32: 515-520
    CrossrefPubMedGoogle Scholar
  • 2 Aird L, Samuel D, Stokes M. Quadriceps muscle tone, elasticity and stiffness in older males. Reliability and symmetry using the MyotonPRO. Arch Gerontol Geriatr 2012; 55: e31-e39
    CrossrefPubMedGoogle Scholar
  • 3 Antonaci F, Sand T, Lucas GA. Pressure algometry in healthy subjects. Inter-examiner variability. Scand J Rehabil Med 1998; 30: 3-8
    CrossrefPubMedGoogle Scholar
  • 4 Ballyns JJ, Shah JP, Hammond J et al. Objective sonographic measures for characterizing myofascial trigger points associated with cervical pain. J Ultrasound Med 2011; 30: 1331-1340
    PubMedGoogle Scholar
  • 5 Bizzini M, Mannion AF. Reliability of a new, hand-held device for assessing skeletal muscle stiffness. Clin Biomech (Bristol, Avon) 2003; 18: 459-461
    CrossrefPubMedGoogle Scholar
  • 6 Bogduk N, Macintosh JE. The applied anatomy of the thoracolumbar fascia. Spine 1984; 9: 164-170
    CrossrefPubMedGoogle Scholar
  • 7 Bojunga J, Herrmann E, Meyer G et al. Real-Time Elastography for the Differentiation of Benign and Malignant Thyroid Nodules. A Meta-Analysis. Thyroid 2010; 20: 1145-1150
    PubMedGoogle Scholar
  • 8 Bota S, Herkner H, Sporea I et al. Meta-analysis. ARFI elastography versus transient elastography for the evaluation of liver fibrosis. Liver Int 2013; 33: 1138-1147
    CrossrefPubMedGoogle Scholar
  • 9 Cardinal E, Chhem RK, Beauregard CG et al. Plantar fasciitis. Sonographic evaluation. Radiology 1996; 201: 257-259
    CrossrefPubMedGoogle Scholar
  • 10 Carneiro-Pla D. Ultrasound elastography in the evaluation of thyroid nodules for thyroid cancer. Curr Opin Oncol 2013; 25: 1-5
    CrossrefPubMedGoogle Scholar
  • 11 Carvalhais VO, Ocarino JdeM, Araújo VL et al. Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles. An in vivo experiment. J Biomech 2013; 46: 1003-1007
    CrossrefPubMedGoogle Scholar
  • 12 Chesterton LS, Sim J, Wright CC et al. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain 2007; 23: 760-766
    CrossrefPubMedGoogle Scholar
  • 13 Drakonaki EE, Allen GM, Wilson DJ. Ultrasound elastography for musculoskeletal applications. Br J Radiol 2012; 85: 1435-1445
    CrossrefPubMedGoogle Scholar
  • 14 English C, Fisher L, Thoirs K. Reliability of real-time ultrasound for measuring skeletal muscle size in human limbs in vivo. A systematic review. Clin Rehabil 2012; 26: 934-944
    CrossrefPubMedGoogle Scholar
  • 15 Haneline MT, Young M. A review of intraexaminer and interexaminer reliability of static spinal palpation. A literature synthesis. J Manipul Physiol Ther 2009; 32: 379-386
    CrossrefPubMedGoogle Scholar
  • 16 Hebert JJ, Koppenhaver SL, Parent EC et al. A systematic review of the reliability of rehabilitative ultrasound imaging for the quantitative assessment of the abdominal and lumbar trunk muscles. Spine 2009; 34: E848-E856
    CrossrefPubMedGoogle Scholar
  • 17 Hou CR, Tsai LC, Cheng KF et al. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Arch Phys Med Rehabil 2002; 83: 1406-1414
    CrossrefPubMedGoogle Scholar
  • 18 Jarocka E, Marusiak J, Kumorek M et al. Muscle stiffness at different force levels measured with two myotonometric devices. Physiol Meas 2012; 33: 65-78
    CrossrefPubMedGoogle Scholar
  • 19 Kassolik K, Jaskólska A, Kisiel-Sajewicz K et al. Tensegrity principle in massage demonstrated by electro- and mechanomyography. J Bod Mov Ther 2009; 13: 164-170
    PubMedGoogle Scholar
  • 20 Kerins CM, Moore SD, Butterfield TA. Reliability of the myotonometer for assessment of posterior shoulder tightness. Int J Sports Phys Ther 2013; 8: 248-255
    PubMedGoogle Scholar
  • 21 Kot BC, Zhang ZJ, Lee AW. Elastic modulus of muscle and tendon with shear wave ultrasound elastography. Variations with different technical settings. PloS one 2012; 7: e443-e448
    PubMedGoogle Scholar
  • 22 Langevin HM, Stevens-Tuttle D, Fox JR et al. Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC Musculoskelet Disord 2009; 10: 151
    CrossrefPubMedGoogle Scholar
  • 23 las Peñas CF, Sohrbeck CM, Fernández Carnero J. et al. Manual therapies in myofascial trigger point treatment. A systematic review. J Body Mov Ther 2005; 9: 27-34
    CrossrefPubMedGoogle Scholar
  • 24 Leonard CT, Deshner WP, Romo JW et al. Myotonometer intra- and interrater reliabilities. Arch Phys Med Rehabil 2003; 84: 928-932
    CrossrefPubMedGoogle Scholar
  • 25 Lewis J, Tehan P. A blinded pilot study investigating the use of diagnostic ultrasound for detecting active myofascial trigger points. Pain 1999; 79: 39-44
    CrossrefPubMedGoogle Scholar
  • 26 List T, Helkimo M, Karlsson R. Influence of pressure rates on the reliability of a pressure threshold meter. J Craniomandib Disord 1991; 5: 173-178
    PubMedGoogle Scholar
  • 27 Lucas N, Macaskill P, Irwig L et al. Reliability of physical examination for diagnosis of myofascial trigger points. A systematic review of the literature. Clin J Pain 2009; 25: 80-89
    CrossrefPubMedGoogle Scholar
  • 28 Maas H, Sandercock TG. Force transmission between synergistic skeletal muscles through connective tissue linkages. J Biomed Biotechnol 2010; Article ID 575672, 9 Seiten
    PubMedGoogle Scholar
  • 29 Maher RM, Hayes DM, Shinohara M. Quantification of dry needling and posture effects on myofascial trigger points using ultrasound shear-wave elastography. Arch Phys Med Rehabil 2013; 94: 2146-2150
    CrossrefPubMedGoogle Scholar
  • 30 McKenny K, Sinclair Elder A, Elder C. Myofascial release as a treatment for orthopaedic conditions. A systematic review. J Athl Train 2013; 48: 522-527
    CrossrefPubMedGoogle Scholar
  • 31 Myburgh C, Larsen AH, Hartvigsen J. A systematic, critical review of manual palpation for identifying myofascial trigger points. Evidence and clinical significance. Arch Phys Med Rehabil 2008; 89: 1169-1176
    CrossrefPubMedGoogle Scholar
  • 32 Nussbaum EL, Downes L. Reliability of clinical pressure-pain algometric measurements obtained on consecutive days. Phys Ther 1998; 78: 160-169
    PubMedGoogle Scholar
  • 33 Pedersen M, Fredberg U, Langberg H. Sonoelastography as a Diagnostic Tool in the Assessment of Musculoskeletal Alterations. A Systematic Review. Ultraschall Med 2012; 33: 441-446
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 34 Posadzki P, Ernst E. Osteopathy for musculoskeletal pain patients. A systematic review of randomized controlled trials. Clin Rheumatol 2011; 30: 285-291
    CrossrefPubMedGoogle Scholar
  • 35 Schleip R, Klingler W, Lehmann-Horn F. Faszien besitzen eine der glatten Muskulatur vergleichbare Kontraktionsfähigkeit und können so die muskuloskelettale Mechanik beeinflussen. Osteopath Med 2008; 9: 19-21
    PubMedGoogle Scholar
  • 36 Schleip R, Duerselen L, Vleeming A et al. Strain hardening of fascia. Static stretching of dense fibrous connective tissues can induce a temporary stiffness increase accompanied by enhanced matrix hydration. J Body Mov Ther 2012; 16: 94-100
    CrossrefPubMedGoogle Scholar
  • 37 Schwerla F, Bischoff A, Nurnberger A et al. Osteopathic Treatment of Patients with Chronic Non-Specific Neck Pain. A Randomised Controlled Trial of Efficacy. Forsch Komplementärmed 2008; 15: 138-145
    CrossrefPubMedGoogle Scholar
  • 38 Selfinger MA, Najm WI, Mishra SI et al. Reliability of spinal palpation for diagnosis of back and neck pain. A systematic review of the literature. Spine 2004; 29: E413-E425
    CrossrefPubMedGoogle Scholar
  • 39 Shea JB, Grimshaw JM, Wells GA et al. Development of AMSTAR. A measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007; 7: 10
    CrossrefPubMedGoogle Scholar
  • 40 Shea JB, Hamel C, Wells GA et al. AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol 2009; 62: 1013-1020
    CrossrefPubMedGoogle Scholar
  • 41 Sikdar S, Shah JP, Gebreab T. Novel applications of ultrasound technology to visualize and characterize myofascial trigger points and surrounding soft tissue. Arch Phys Med Rehabil 2009; 90: 1829-1838
    CrossrefPubMedGoogle Scholar
  • 42 Simmonds N, Miller P, Gemmell H. A theoretical framework for the role of fascia in manual therapy. J Body Mov Ther 2012; 16: 83-93
    CrossrefPubMedGoogle Scholar
  • 43 Staubesand J, Li Y. Begriff und Substrat der Fasziensklerose bei chonisch-venöser Insuffizienz. Ultrastrukturelle Studien an der Fascia cruris. Phlebol 1997; 26: 72-79
    PubMedGoogle Scholar
  • 44 Stecco A, Macchi V, Masiero S et al. Pectoral and femoral fasciae. Common aspects and regional specializations. Surg Radiol Anat 2009; 31: 35-42
    CrossrefPubMedGoogle Scholar
  • 45 Stecco A, Macchi V, Stecco C et al. Anatomical study of myofascial continuity in the anterior region of the upper limb. J Body Mov Ther 2009; 13: 53-62
    CrossrefPubMedGoogle Scholar
  • 46 Stecco A, Masiero S, Macchi V et al. The pectoral fascia. Anatomical and histological study. J Body Mov Ther 2009; 13: 255-261
    CrossrefPubMedGoogle Scholar
  • 47 Stecco A, Meneghini A, Stern R et al. Ultrasonography in myofascial neck pain. Randomized clinical trial for diagnosis and follow-up. Surg Radiol Anat 2013; Epub ahead of print
    PubMedGoogle Scholar
  • 48 Stecco A, Wolfgang G, Robert H et al. The anatomical and functional relation between gluteus maximus and fascia lata. J Body Mov Ther 2013; Epub ahead of print
    PubMedGoogle Scholar
  • 49 Stecco C, Porzionato A, Macchi V et al. The expansions of the pectoral girdle muscles onto the brachial fascia. Morphological aspects and spatial disposition. Cells Tissues Organs 2008; 188: 320-329
    CrossrefPubMedGoogle Scholar
  • 50 Stecco C, Porzionato A, Macchi V et al. Histological characteristics of the deep fascia of the upper limb. Ital J Anat Embryol 2006; 111: 105-110
    PubMedGoogle Scholar
  • 51 Stecco C, Stern R, Porzionato A et al. Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat 2011; 33: 891-896
    CrossrefPubMedGoogle Scholar
  • 52 Stecco C, Corradin M, Macchi V. Plantar fascia anatomy and its relationship with achilles tendon and paratenon. J Anat 2013; Epub ahead of print
    PubMedGoogle Scholar
  • 53 Tesarz J, Hoheisel U, Wiedenhöfer B et al. Sensory innervation of the thoracolumbar fascia in rats and humans. Neuroscience 2011; 194: 302-308
    CrossrefPubMedGoogle Scholar
  • 54 Tozzi P, Bongiorno D, Vitturini C. Fascial release effects on patients with non-specific cervical or lumbar pain. J Body Mov Ther 2011; 15: 405-416
    CrossrefPubMedGoogle Scholar
  • 55 Turo D, Otto P, Shah JP et al. Ultrasonic characterization of the upper trapezius muscle in patients with chronic neck pain. Ultrason Imaging 2013; 35: 173-187
    CrossrefPubMedGoogle Scholar
  • 56 Viir R, Laiho K, Kramarenko J et al. Repeatability of trapezius muscle tone assessment by myometric method. J Mech Med Biol 2006; 6: 215-228
    CrossrefPubMedGoogle Scholar
  • 57 Vleeming A, Pool-Goudzwaard A, Stoeckart R. The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Spine 1995; 20: 753-758
    CrossrefPubMedGoogle Scholar
  • 58 Wang QB, Zhu H, Liu HL. Performance of magnetic resonance elastography and diffusion-weighted imaging for the staging of hepatic fibrosis. A meta-analysis. Hepatology 2012; 56: 239-247
    CrossrefPubMedGoogle Scholar
  • 59 Williamson A, Hoggart B. Pain. A review of three commonly used pain rating scales. J Clin Nurs 2005; 14: 798-804
    CrossrefPubMedGoogle Scholar
  • 60 Wu CH, Chen WS, Park GY et al. Musculoskeletal Sonoelastography. A focused review of its diagnostic applications for evaluating tendons and fascia. J Med Ultrasound 2012; 20: 79-86
    CrossrefPubMedGoogle Scholar
  • 61 Yahia L, Rhalmi S, Newman N et al. Sensory innervation of human thoracolumbar fascia. An immunohistochemical study. Acta Orthop Scand 1992; 63: 195-197
    CrossrefPubMedGoogle Scholar
  • 62 Yahia LH, Pigeon P, DesRosiers EA. Viscoelastic properties of the human lumbodorsal fascia. J Biomed Eng 1993; 15: 425-429
    CrossrefPubMedGoogle Scholar