Academic Information | Standardization Scheme for Ultrasound Guided Needle Knife Combined with Biomechanics Quantitative Evaluation - Visualization and Quantification Diagnosis and Treatment of Pain in the trapezius Muscle Fascia

Published on： 2026-08-12 14:55

Recently, a team from the Rehabilitation Medicine Department of Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine, published an article in the Journal of Visualization Experimental MethodologyJournal of Visualized Experiments(JoVE, Medline/SCI) published a standardized protocol paper that systematically demonstrated the complete process of ultrasound-guided needle knife layered release combined with portable shear wave elastography (pSWE) and digital palpation technology for the evaluation and intervention of trapezius myofascial pain syndrome (MPS).

The study provides a reproducible methodological reference for the diagnosis, treatment, and efficacy evaluation of MPS by quantitatively tracking mechanical related indicators such as equivalent shear modulus (G-value) throughout the entire cycle in both resting and passive stretching states.

The multi parameter mechanical quantitative evaluation capability of Xijian Technology's skeletal muscle mechanics quantitative testing equipment (M5) is reflected in the research instituteSkeletal muscle multi posture, standardized mechanical quantitative acquisition pathHighly compatible and capable of serving various soft tissue mechanics assessment scenarios.

PART01

Research Background

Breaking the dual bottleneck of traditional "blindness" and "subjective evaluation"

The trapezius muscle is one of the most commonly affected muscle groups in MPS. Traditional needle knife loosening relies more on the surgeon's experience positioning, and even with real-time imaging guidance, the depth, level, and number of loosening are difficult to standardize; The efficacy evaluation relies on subjective scales such as Visual Analog Scale (VAS) for a long time, which makes it difficult to objectively capture changes in the mechanical state of soft tissues.

This study incorporates two types of technologies into the same standardization path:

Ultrasound visualization guidance

High frequency ultrasound can display the real-time relationship between fascia layers and needle knife positions, supporting precise release of superficial and deep fascia layers.

Biomechanical quantitative evaluation

PSWE is used to quantify the equivalent shear modulus (G-value, kPa) of skeletal muscle; Digital palpation equipment is also used to collect mechanical related indicators and complete measurements separately in the resting state and passive stretching state.

PART02

Experimental Design and Process

Experimental Design and Procedures

Subjects and Grouping

The final analysis included 43 patients with oblique muscle MPS (6 unilateral and 37 bilateral), totaling 80 affected sides. Each affected side of the bilateral case was randomly assigned:

Group	intervention content
Needle knife loosening group	Ultrasound guided needle knife release of superficial and deep fascia layers
Fake Needle Knife Group	Subcutaneous needle insertion under ultrasound guidance,Not penetrating the fascia
blank control group	Do not accept needle intervention and complete the evaluation at the corresponding time point

Due to the difference in needle insertion depth between the real needle knife and the fake needle knife, the subjects were not blinded; The outcome assessors and statisticians remained blinded to grouping.

Key points of operation and evaluation

Identifying therapeutic targets

The patient points out the most painful area, and the surgeon determines the maximum tender point within the tension zone, and combines ultrasound to search for local pathological thickening of the fascia.The individualized therapeutic target may not necessarily coincide completely with standardized measurement points.

Ultrasonic exploration

Use a high-frequency linear array probe to scan and identify areas of fascia thickening. Adjacent to normal fasciaThickening over 2mmAccompanied by uneven echo and limited sliding.

Layered relaxation

The superficial fascia is approximately10°–15°Angle needle insertion; Complete the shallow operation and retreat to the subcutaneous area, then adjust to about45°Enter the deep fascia. Each layer is conducted3-5 timesRelease the movement until there is a "sense of frustration" or ultrasound shows improvement in fascia separation and sliding.

Standardized measurement points and dual attitude evaluation

The measurement point is located in the shoulder well acupoint area (near the midpoint of the line connecting the C7 spinous process and the outermost shoulder peak on the same side). respectivelyResting state and passive lateral flexion towards the healthy side at approximately 30 ° -45 °Under the stretching state, complete pSWE and digital palpation measurements.

Observation time point

baseAbout 30 minutes (referred to as week 0 in the text), 1 week, and 2 weeks after treatment

Measurement reliability

Conduct reliability assessment on 10 volunteers and 20 measurement sides, report:

ICC between testers=0.970
ICC within the tester=0.984

Both results reached an excellent level, indicating excellent inter/intra rater reliability in biomechanical measurements.

PART03

Research results

Key Research Findings

VAS pain score

VAS score results of needle knife loosening group:

Both week 1 and week 2 within the group showed a significant decrease compared to baseline and week 0 (both P<0.001).
Inter group: At 1 and 2 weeks, the needle knife group was significantly lower than the sham needle knife group and the blank control group (both P<0.001).
There was no significant intra group change observed between the sham needle knife group and the blank control group.

Tip: Ultrasound guided needle knife release has a clearShort term pain relief signal.

Biomechanics parameters (mainly changes within the needle knife group)

parameter	Main changes
Resting state G-value	0 weeks, 1 week, and 2 weeks all decreased compared to baseline
Stretching state G-value	Transient increase from week 1 to week 0
muscle tone tone	Resting and stretching states decreased at 1 and 2 weeks compared to 0 weeks
Dynamic hardness stiffness	Both postures decreased in week 1 and 2 compared to week 0
Elasticity related indicators	Resting state improved after 1 week compared to 0 weeks; At 2 weeks, both postures improved compared to baseline and 0 weeks

The fake needle knife group and the blank control group did not show a sustained improvement pattern in the same direction and magnitude as the needle knife group as a whole.

PART04

Significance of the Study

Research Significance

Write experiential operations into reproducible protocols

JoVE features video based experimental methods. This paper provides a complete display of body position, target localization, ultrasound parameters, needle insertion angle, fascia stratification, and measurement process, which is helpful for clinical training, method replication, and subsequent optimization.

Constructing an objective evaluation approach of "multi posture, multi parameter"

Introducing pSWE and digital palpation beyond VAS to enable quantitative recording of soft tissue mechanical changes; The combination of resting state and passive stretching state is helpful for observing tissue response under different mechanical loads.

The soft tissue mechanics quantification capability of the Xijian Technology Skeletal Muscle Mechanics Quantitative Testing Equipment (M5) is consistent with the resting/stretching dual posture and standardized acquisition path reflected in the paper, and can support such mechanical evaluation and scientific research quality control scenarios.

PART05

Summary and Outlook

Conclusion and Outlook

This study established a standardized protocol for "ultrasound-guided needle knife layered release+multi posture biomechanical quantitative evaluation". Short term results showed that the needle knife group showed clear VAS improvement at 1 and 2 weeks; Some biomechanical parameters showed significant intra group changes.

In the future, this evaluation framework will be extended to other MPS prone areas - the direction has methodological reference value and can be independently validated by muscle groups in the future.

With the development of ultrasound-guided and quantitative techniques in soft tissue mechanics, MPS evaluation is expected to further advanceVisual, quantifiable, and reproducible.Xijian Technology will continue to promote the collaborative iteration of equipment, algorithms, and standardized evaluation schemes, providing objective and traceable soft tissue mechanics evaluation tools for rehabilitation medicine, sports health, and clinical research.

Click on the link above to watch the paper video

About Xijian

Beijing Xijian Technology Co., Ltd. is based on more than ten years of research foundation in the field of human soft tissue mechanics characterization in the Laboratory of Biomaterials and Soft Materials Mechanics at Tsinghua University. It is committed to promoting the industrialization of human biomechanical imaging platform technology, focusing on clinical blue ocean demand markets such as sports health, dermatology, and major disease diagnosis and treatment.

Editor: Geng Tianshui | Producer: Zhang Liga

Design material source: Maker post, 96 editor

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