Effectiveness of Second-Generation Focused Extracorporeal Shockwave Therapy Combined With Ultrasonographic Assessment in Myofascial Pain Syndrome of the Neck and Shoulder: A Pilot Randomized Controlled Trial

Myofascial pain syndrome of the neck and shoulder is a common musculoskeletal pain condition characterized by painful and sensitive areas within tight bands of muscle, commonly referred to as myofascial trigger points. These trigger points frequently occur in the upper trapezius and levator scapulae muscles and may cause localized pain, referred pain, muscle stiffness, reduced neck movement, sleep disturbance, and limitations in work and daily activities. Persistent symptoms may also contribute to altered posture, reduced muscle performance, and decreased quality of life.

Focused extracorporeal shockwave therapy is a noninvasive treatment that delivers acoustic energy to painful soft tissues. Proposed effects include improved local circulation, modulation of pain-related nerve signaling, reduction of abnormal muscle tension, and stimulation of tissue repair. Second-generation focused shockwave systems use piezoelectric technology to provide a stable and precisely focused energy field. This technology may be particularly suitable for treating relatively superficial muscles, such as the upper trapezius.

Ultrasound imaging provides a noninvasive method for evaluating muscle structure and function. In addition to measuring resting muscle thickness, ultrasound can be used to assess changes in muscle thickness during different levels of contraction. These measurements may provide objective information regarding muscle function that cannot be obtained from pain questionnaires alone. In this study, ultrasound imaging will be used only as an outcome assessment tool and will not be used to guide the location of shockwave treatment.

This study is a pilot randomized controlled trial designed to evaluate the effectiveness of second-generation focused extracorporeal shockwave therapy in adults with chronic neck and shoulder myofascial pain syndrome. Approximately 60 participants will be enrolled and randomly assigned in a 1:1 ratio to either a focused shockwave therapy group or a home-based neck exercise group.

Eligible participants will be adults older than 20 years who have had nonspecific neck and shoulder pain for at least 3 months. The pain must primarily arise from muscles and soft tissues in the upper trapezius or levator scapulae region, as determined by a physical medicine and rehabilitation physician. Participants must also have a Neck Disability Index score greater than 5 and must not have recently received pain medication, muscle relaxants, injections, physical therapy, or other related treatment.