RT Journal Article
T1 Determining Pain Pressure Thresholds and Muscle Stiffness Cut-Offs to Discriminate Latent Myofascial Trigger Points and Asymptomatic Infraspinatus Muscle Locations: A Diagnostic Accuracy Study
A1 Kobylarz, Mateusz D.
A1 Ortega Santiago, Ricardo
A1 Sánchez Jorge, Sandra
A1 Kołacz, Marcin
A1 Kosson, Dariusz
A1 Monclús Díez, Germán
A1 Valera Calero, Juan Antonio
A1 López Redondo, Mónica
AB Background: Latent myofascial trigger points (MTrPs) are clinically relevant because they lower local pressure pain thresholds (PPTs), can perturb motor control, and may sustain shoulder symptoms even when overt pain is absent. However, even if previous studies assessed stiffness and mechanosensitivity differences between MTrPs and asymptomatic regions, objective patient-level cut-offs and diagnostic-accuracy metrics to distinguish latent MTrPs from adjacent asymptomatic tissue are lacking. Objective: To quantify the diagnostic accuracy of pressure algometry (PPT) and shear-wave elastography (SWE) for distinguishing latent MTrPs from adjacent asymptomatic tissue. Methods: A single-center cross-sectional study was conducted including 76 volunteers with ≥1 latent infraspinatus MTrP (assessed by following the current Delphi consensus criteria). The most sensitive latent MTrP and a control site 2 cm cranial was measured on the dominant side infraspinatus muscle in each participant. PPT and SWE were acquired with a standardized protocol (long-axis imaging, anisotropy control, minimal probe pressure; three captures per site; 1 cm rectangular ROI; operator blinded to site type). ROC analyses estimated areas under the curve (AUCs), Youden-optimal cut-offs, sensitivity, specificity, and likelihood ratios (LR+/−). Results: Latent MTrPs showed lower PPTs than controls (p < 0.001) and higher stiffness (shear modulus: p = 0.009; shear-wave speed: p = 0.022). PPT yielded AUC = 0.704 with an optimal cut-off of 47.5 N (sensitivity 0.75; specificity 0.592; LR+ 1.84; LR− 0.42), outperforming SWE metrics (shear modulus AUC 0.611; cut-off 23.6 kPa; sensitivity 0.632; specificity 0.605; LR+ 1.60; LR− 0.61; shear-wave speed AUC 0.601; cut-off 2.55 m/s; sensitivity 0.592; specificity 0.632; LR+ 1.61; LR− 0.65). Conclusions: In the infraspinatus, PPT provides moderate discrimination between latent MTrPs and adjacent asymptomatic tissue, whereas resting SWE—despite small mean differences—exhibited lower accuracy. These findings support mechanosensitivity as a primary measurable signal and position SWE as an adjunct. External validation across devices and operators, and multivariable models integrating sensory, imaging, and clinical features, are warranted.
PB Multidisciplinary Digital Publishing Institute (MDPI)
SN 2075-4418
YR 2025
FD 2025-10-18
LK https://hdl.handle.net/20.500.14352/132037
UL https://hdl.handle.net/20.500.14352/132037
LA eng
NO Kobylarz MD, Ortega-Santiago R, Sánchez-Jorge S, Kołacz M, Kosson D, Monclús-Díez G, et al. Determining Pain Pressure Thresholds and Muscle Stiffness Cut-Offs to Discriminate Latent Myofascial Trigger Points and Asymptomatic Infraspinatus Muscle Locations: A Diagnostic Accuracy Study. Diagnostics. 2025;15(20).
DS Docta Complutense
RD 27 feb 2026