T1ρ-Mapping for Musculoskeletal Pain Diagnosis: Case Series of Variation of Water Bound Glycosaminoglycans Quantification before and after Fascial Manipulation® in Subjects with Elbow Pain

Rajiv G Menon, Stephen F Oswald, Preeti Raghavan, Ravinder R Regatte, Antonio Stecco, Rajiv G Menon, Stephen F Oswald, Preeti Raghavan, Ravinder R Regatte, Antonio Stecco

Abstract

Diagnosis and management of musculoskeletal pain is a major clinical challenge. Following this need, the first aim of our study was to provide an innovative magnetic resonance technique called T1ρ to quantify possible alterations in elbow pain, a common musculoskeletal pain syndrome that has not a clear etiology. Five patients were recruited presenting chronic elbow pain (>3 months), with an age between 30 and 70 years old. Patients underwent two T1ρ-mapping evaluations, one before and one after the series of Fascial Manipulation® (FM) treatments. After the first MRI evaluation, a Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to quantify the symptoms and pain intensity. Patients then received three sessions of FM, once a week for 40 min each. A statistically significant difference was found between bound and unbound water concentration before and after FM treatment. Our preliminary data suggest that the application of the manual method seems to decrease the concentration of unbound water inside the deep fascia in the most chronic patients. This could explain the change in viscosity perceived by many practitioners as well as the decrease of symptoms due to the restoration of the normal property of the loose connective tissue. Being able to identify an altered deep fascial area may better guide therapies, contributing to a more nuanced view of the mechanisms of pain.

Keywords: T1ρ; epicondylitis; fascial manipulation.

Conflict of interest statement

R.R.R., R.G.M., and P.R. do not have any potential conflict of interests. S.F.O. and A.S. are teachers associated with the Fascial Manipulation Association. The association is non-profit, with the objective of promoting and supporting research in the field of pain relief in general and, in particular, in the field of anatomy and physiopathology of the fasciae.

Figures

Figure 1
Figure 1
Treatment over the center of coordination ER-CA (see Figure 2).
Figure 2
Figure 2
Location of the center of coordination. AN = antemotion; RE = retromotion; ME = mediomotion; LA = lateromotion; IR = intrarotation; ER = extrarotation. The blue dots represent the slides were coronal MRI were made.
Figure 3
Figure 3
Region of interest (ROI) in one slide post-treatment. The ROI is the black line located below the skin at the level of the deep fascia in this transversal section of the forearm.
Figure 4
Figure 4
(A) Pretreatment of T1 MRI where the thickness of the brachial fascia is evident. The fascia is the black ring below the skin identified by the arrow. (B) Pretreatment T1ρ-mapping where the higher concentration of unbounded water is evident (water that it is not linked with any glycosaminoglycan or hyaluronan) within the brachial fascia in the symptomatic side (white arrow).
Figure 5
Figure 5
Pre- and post-T1ρ-mapping of brachial fascia (in ms). The white arrows show the areas that were considered the most symptomatic from the patient. It can be seen a change of the color from red (unbound water) in the pre-treatment imaging to green-blue (bound water that works as a lubricant) in the post-treatment imaging.

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