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Chen X, Chen S, Zhang F, Zhu Y, Yi D, Xu H, Tang J, Zhang Q, Wang Y. Ultrasonic shear wave elastography predicts the quality of the residual tendon before the rotator cuff repair. Insights Imaging 2024; 15:72. [PMID: 38483642 PMCID: PMC10940563 DOI: 10.1186/s13244-024-01642-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND AND PURPOSE Effective evaluation of rotator cuff tear residual tendon quality is the key to surgical repair. However, until now, the evaluation of rotator cuff tissue by ultrasonic shear wave elasticity (SWE) has been controversial. This prospective study analyzed the association between preoperative SWE and arthroscopic residual tendon quality scores. METHODS The shear wave velocity (SWV) of the deltoid muscle, the supraspinatus tendon, and the supraspinatus muscle were measured in full-thickness rotator cuff tear patients. Tendon quality was scored according to tear size, tendon margin, tendon thickness, and footprint coverage during arthroscopy. The arthroscopic scores were used as the gold standard, and the SWV ratio of tendon and muscle (supraspinatus tendon/deltoid and supraspinatus muscle/deltoid) were calculated and correlated with the arthroscopic scores. RESULT Eighty-nine patients (129 shoulders) were enrolled, including 89 operation shoulders and 40 control shoulders. In the group of operation shoulders, both the SWV ratios of tendon (SWV-RT) and the SWV ratio of muscle (SWV-RM) were negatively correlated with arthroscopic scores (The correlation coefficient (R) ranged from -0.722 to -0.884 and -0.569 to -0.689). The SWV-RT and SWV-RM of the operation shoulders were significantly lower than that of the control shoulders (p < 0.05). CONCLUSION SWE could be used to predict the quality of the residual tendon before the rotator cuff repair. SWV of the supraspinatus tendon and muscle was a useful parameter to predict the quality of the residual tendon. CRITICAL RELEVANCE STATEMENT Measuring the shear wave velocity of the supraspinatus tendon and muscle with SWE is useful for predicting the quality of the residual tendon which is one of the key factors for a successful rotator cuff repair. KEY POINTS • Evaluating the quality of the residual tendon is important before surgery. • Elasticity measurements were negatively correlated with the arthroscopic score. • SWE is useful for predicting the quality of the residual tendon.
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Affiliation(s)
- Xianghui Chen
- Department of Ultrasound, Third Medical Center of PLA General Hospital, Yongding Road 69, Beijing, 100853, China
| | - Siming Chen
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Fei Zhang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Yaqiong Zhu
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Dan Yi
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Hong Xu
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Jie Tang
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Qiang Zhang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Yuexiang Wang
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
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Nasr AJ, Pierson CJ, Tzen YT, Khazzam M, Jain NB, Lin YS. Emerging Role of Quantitative Ultrasound-Based Imaging Techniques for Characterizing Rotator Cuff Tears: A Scoping Review. Diagnostics (Basel) 2023; 13:2011. [PMID: 37370906 DOI: 10.3390/diagnostics13122011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Rotator cuff myosteatosis following cuff tears is very common and one of the most important prognostic factors in clinical management. Quantitative ultrasound-based imaging techniques (QUBIT) are frequently used along with magnetic resonance imaging (MRI) to evaluate rotator cuff fatty degeneration. However, the examination of rotator cuff tissue integrity by QUBIT is lacking a standardized imaging protocol and procedural methodologies. In this scoping review, we synthesized the current state of QUBIT against the reference imaging modalities in patients with rotator cuff tears. The literature search was extracted from 963 studies, with 22 studies included in the final review in accordance with the preferred reporting items for systematic reviews and meta-analyses extensions for scoping reviews. The selected studies included human participants and focused on measuring at least one prognostic or diagnostic factor using ultrasonography-based imaging with reference to MRI. The findings suggest both conventional B-mode ultrasound and shear wave elastography imaging were comparable to MRI-based imaging techniques for the evaluation of fatty infiltration and rotator cuff tear characterization. This review establishes guidelines for reporting shoulder-specific QUBIT aimed at developing a standardized imaging protocol. The objective was to enhance the diagnostic and prognostic capabilities of QUBIT in the clinical setting.
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Affiliation(s)
- Andrew J Nasr
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Chris J Pierson
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Yi-Ting Tzen
- Department of Applied Clinical Research, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Michael Khazzam
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Nitin B Jain
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Yen-Sheng Lin
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX 75390, USA
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Ashir A, Jerban S, Barrère V, Wu Y, Shah SB, Andre MP, Chang EY. Skeletal Muscle Assessment Using Quantitative Ultrasound: A Narrative Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:4763. [PMID: 37430678 PMCID: PMC10222479 DOI: 10.3390/s23104763] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 07/12/2023]
Abstract
Ultrasound (US) is an important imaging tool for skeletal muscle analysis. The advantages of US include point-of-care access, real-time imaging, cost-effectiveness, and absence of ionizing radiation. However, US can be highly dependent on the operator and/or US system, and a portion of the potentially useful information carried by raw sonographic data is discarded in image formation for routine qualitative US. Quantitative ultrasound (QUS) methods provide analysis of the raw or post-processed data, revealing additional information about normal tissue structure and disease status. There are four QUS categories that can be used on muscle and are important to review. First, quantitative data derived from B-mode images can help determine the macrostructural anatomy and microstructural morphology of muscle tissues. Second, US elastography can provide information about muscle elasticity or stiffness through strain elastography or shear wave elastography (SWE). Strain elastography measures the induced tissue strain caused either by internal or external compression by tracking tissue displacement with detectable speckle in B-mode images of the examined tissue. SWE measures the speed of induced shear waves traveling through the tissue to estimate the tissue elasticity. These shear waves may be produced using external mechanical vibrations or internal "push pulse" ultrasound stimuli. Third, raw radiofrequency signal analyses provide estimates of fundamental tissue parameters, such as the speed of sound, attenuation coefficient, and backscatter coefficient, which correspond to information about muscle tissue microstructure and composition. Lastly, envelope statistical analyses apply various probability distributions to estimate the number density of scatterers and quantify coherent to incoherent signals, thus providing information about microstructural properties of muscle tissue. This review will examine these QUS techniques, published results on QUS evaluation of skeletal muscles, and the strengths and limitations of QUS in skeletal muscle analysis.
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Affiliation(s)
- Aria Ashir
- Department of Radiology, University of California, San Diego, CA 92093, USA; (S.J.); (M.P.A.); (E.Y.C.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (V.B.); (S.B.S.)
- Department of Radiology, Santa Barbara Cottage Hospital, Santa Barbara, CA 93105, USA
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, CA 92093, USA; (S.J.); (M.P.A.); (E.Y.C.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (V.B.); (S.B.S.)
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA;
| | - Victor Barrère
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (V.B.); (S.B.S.)
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA;
| | - Yuanshan Wu
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA;
- Department of Bioengineering, University of California, San Diego, CA 92093, USA
| | - Sameer B. Shah
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (V.B.); (S.B.S.)
- Department of Orthopaedic Surgery, University of California, San Diego, CA 92093, USA;
- Department of Bioengineering, University of California, San Diego, CA 92093, USA
| | - Michael P. Andre
- Department of Radiology, University of California, San Diego, CA 92093, USA; (S.J.); (M.P.A.); (E.Y.C.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (V.B.); (S.B.S.)
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego, CA 92093, USA; (S.J.); (M.P.A.); (E.Y.C.)
- Research Service, Veterans Affairs San Diego Healthcare System, San Diego, CA 92161, USA; (V.B.); (S.B.S.)
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Dilip D, Khaladkar SM, Chanabasanavar V, Parripati SSVK. REAL-TIME strain elastography: Applications in musculoskeletal system. J Clin Orthop Trauma 2022; 26:101784. [PMID: 35211373 PMCID: PMC8844902 DOI: 10.1016/j.jcot.2022.101784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Strain or compression sonoelastography (CE) provides a colour-coded elastogram representing tissue elasticity by measuring tissue deformability after repeated probe compression. Elastographic ultrasound (EUS) is a valuable tool for screening diagnosis and follow-up of inflammatory, degenerative, benign and malignant neoplastic pathologies of skin, subcutaneous tissue, muscles, tendons, ligaments, fascia and nerves; help in targeted biopsy; monitor healing tendons after surgery or nerve stiffness changes during physiotherapy. OBJECTIVES To assess stiffness of normal tendons, muscles and nerve. To diagnose cellulitis, fasciitis, abscess, tendinopathy, myositis, muscle/tendon rupture/contusion and differentiate between benign and malignant soft tissue tumours. To derive elastic score (ES) and strain ratio (SR) in cases and controls. To correlate B-mode findings with CE. MATERIALS AND METHODS A prospective study on 50 healthy subjects between 25 and 30 years and 50 cases of diffuse and focal musculoskeletal pathologies was done using B-mode and CE over 2 years. Statistical analysis of distribution, mean, associations, sensitivity, specificity, area under Receiver Operating Characteristic curve (AUROC) for B-mode, ES, SR combined B-mode/CE and their comparison was done. RESULTS Significant association was noted between SR in muscles and tendons with sex. Significant correlation was noted between ES/SR with B-mode. CE and B-mode had 100% and 52.4% sensitivity respectively for diagnosing diffuse pathologies. For differentiating benign and malignant masses sensitivity, specificity, and diagnostic accuracy of B-mode was 71.43%, 86.36% and 82.76%; of SR was 71.43%, 90.91% and 86.21%; of Combined B-mode with CE was 100%, 90.91% and 93.1% respectively. Elastographic pattern had highest diagnostic accuracy and largest AUROC. CONCLUSION CE as a screening test had higher diagnostic accuracy, supporting need for standardizing it for clinical use in MSK. EUS being a widely available, fast and affordable modality, can aid follow up of chronic MSK pathologies, response to medication, physiotherapy and surgery and mitigate the need for MRI.
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Affiliation(s)
- Darshana Dilip
- Corresponding author. Department of Radio-diagnosis, Dr. D Y Patil Medical College, Hospital and Research centre, Pimpri, Pune, Maharashtra, 411018, India.
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Leigheb M, de Sire A, Colangelo M, Zagaria D, Grassi FA, Rena O, Conte P, Neri P, Carriero A, Sacchetti GM, Penna F, Caretti G, Ferraro E. Sarcopenia Diagnosis: Reliability of the Ultrasound Assessment of the Tibialis Anterior Muscle as an Alternative Evaluation Tool. Diagnostics (Basel) 2021; 11:diagnostics11112158. [PMID: 34829505 PMCID: PMC8624824 DOI: 10.3390/diagnostics11112158] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 12/28/2022] Open
Abstract
Sarcopenia is a skeletal muscle disorder characterized by reduced muscle mass, strength, and performance. Muscle ultrasound can be helpful in assessing muscle mass, quality, and architecture, and thus possibly useful for diagnosing or screening sarcopenia. The objective of this study was to evaluate the reliability of ultrasound assessment of tibialis anterior muscle in sarcopenia diagnosis. We included subjects undergoing total or partial hip replacement, comparing measures with a healthy control group. We measured the following parameters: tibialis anterior muscle thickness, echogenicity, architecture, stiffness, skeletal muscle index (SMI), hand grip strength, and sarcopenia related quality of life evaluated through the SarQoL questionnaire. We included 33 participants with a mean age of 54.97 ± 23.91 years. In the study group we found reduced tibialis anterior muscle thickness compared to the healthy control group (19.49 ± 4.92 vs. 28.94 ± 3.63 mm, p < 0.05) with significant correlation with SarQoL values (r = 0.80, p < 0.05), dynamometer hand strength (r = 0.72, p < 0.05) and SMI (r = 0.76, p < 0.05). Moreover, we found reduced stiffness (32.21 ± 12.31 vs. 27.07 ± 8.04 Kpa, p < 0.05). AUC measures of ROC curves were 0.89 predicting reduced muscle strength, and 0.97 predicting reduced SMI for tibialis anterior muscle thickness, while they were 0.73 and 0.85, respectively, for muscle stiffness. Our findings showed that ultrasound assessment of tibialis anterior muscle might be considered a reliable measurement tool to evaluate sarcopenia.
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Affiliation(s)
- Massimiliano Leigheb
- Orthopaedics and Traumatology Unit, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy; (M.L.); (M.C.)
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961712819
| | - Matteo Colangelo
- Orthopaedics and Traumatology Unit, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy; (M.L.); (M.C.)
| | - Domenico Zagaria
- Radiology Unit, “Maggiore della Carità” Hospital, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy; (D.Z.); (P.C.); (P.N.); (A.C.)
| | - Federico Alberto Grassi
- Orthopaedics and Traumatology Unit, IRCCS Policlinico San Matteo, Department of Clinical-Surgical, Diagnostics and Pediatrics Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Ottavio Rena
- Thoracic Surgery Unit, “Maggiore della Carità” Hospital, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Patrizio Conte
- Radiology Unit, “Maggiore della Carità” Hospital, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy; (D.Z.); (P.C.); (P.N.); (A.C.)
| | - Pierluigi Neri
- Radiology Unit, “Maggiore della Carità” Hospital, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy; (D.Z.); (P.C.); (P.N.); (A.C.)
| | - Alessandro Carriero
- Radiology Unit, “Maggiore della Carità” Hospital, Department of Translational Medicine, University of Piemonte Orientale, 28100 Novara, Italy; (D.Z.); (P.C.); (P.N.); (A.C.)
| | | | - Fabio Penna
- Department of Clinical and Biological Sciences, University of Torino, 10125 Torino, Italy;
| | | | - Elisabetta Ferraro
- Cell and Developmental Biology Unit, Department of Biology, University of Pisa, 56127 Pisa, Italy;
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Oh JH, Kim JY, Nam KP, Kang HD, Yeo JH. Immediate Changes and Recovery of the Supraspinatus, Long Head Biceps Tendon, and Range of Motion after Pitching in Youth Baseball Players: How Much Rest Is Needed after Pitching? Sonoelastography on the Supraspinatus Muscle-Tendon and Biceps Long Head Tendon. Clin Orthop Surg 2021; 13:385-394. [PMID: 34484632 PMCID: PMC8380532 DOI: 10.4055/cios20187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022] Open
Abstract
Backgroud Baseball players are subjected to repeated loads on the supraspinatus and long head biceps tendon from youth, and repetitive pitching motions can cause shoulder injuries. The purpose of this study was to evaluate the immediate changes caused by pitching in the supraspinatus muscle-tendon, long head of the bicep tendon (LHBT), and shoulder range of motion (ROM) and to verify their recovery over time in youth baseball players. Methods Fifteen youth baseball players (mean age, 11.5 ± 1.3 years) were enrolled. The thicknesses of the supraspinatus tendon and LHBT and the strain ratios (SRs) of supraspinatus muscle and tendon were measured by sonoelastography. ROMs of shoulder joints (abduction, external rotation at 90° of abduction [ABER], and internal rotations at 90° of abduction [ABIR]) and horizontal adduction (HA) were measured using a goniometer. All measurements were performed on the throwing shoulders before and immediately after pitching (mean pitch count, 78.3 ± 13.3) and at 30 minutes, 24 hours, and 72 hours after pitching. Results The thickness of supraspinatus tendon (6.64–6.27 mm, p = 0.026) and that of LHBT (2.56–2.26 mm, p = 0.021) significantly decreased immediately after pitching. The SRs of supraspinatus muscle tended to decrease, whereas SRs of supraspinatus tendon tended to increase immediately after pitching. ABER increased (119.7°–127.3°, p = 0.001) and HA decreased (34.7°–29.3°, p = 0.023) immediately after pitching. All immediate changes recovered 72 hours after pitching. Conclusions The immediate effects of pitching on the supraspinatus muscle-tendon, LHBT, and shoulder ROM in youth baseball players were confirmed in the current study. These changes were recovered to pre-pitch levels 72 hours after pitching. Therefore, we recommend that youth baseball players should rest for three days after pitching to minimize the risk of shoulder injury.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Yub Kim
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon, Korea
| | - Kyoung Pyo Nam
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon, Korea
| | | | - Ji Hyun Yeo
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
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Tenbrunsel TN, Whaley JD, Golchian D, Malone DL, Lima DJL, Sabesan VJ. Efficacy of Imaging Modalities Assessing Fatty Infiltration in Rotator Cuff Tears. JBJS Rev 2020; 7:e3. [PMID: 30969180 DOI: 10.2106/jbjs.rvw.18.00042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Fatty atrophy is a diagnosis characterized by the combination of fatty infiltration and muscle atrophy of the rotator cuff. Studies have shown a strong positive correlation between the level of fatty infiltration and the risk of experiencing a chronic rotator cuff tear. Therefore, the purpose of the present study was to review the current literature on radiographic imaging of fatty infiltration and fatty atrophy to better aid surgeons in predicting functional outcome and to help guide patient decisions. METHODS We conducted a literature search in PubMed. The exact search queries included "rotator cuff" in the MeSH Terms field; "fatty atrophy," fatty infiltration," and "fatty muscle degeneration" in the Title/Abstract field; and various combinations of these searches. We initially found 184 articles using these keywords, including both human and animal studies. The 25 animal studies were excluded, leaving 159 articles. The abstracts of all remaining articles were reviewed and selected on the basis of our inclusion criteria of focusing on patients with rotator cuff tears (preoperatively and postoperatively), fatty infiltration, fatty atrophy, and imaging modalities. We excluded an additional 127 articles, leaving 32 articles that were selected for the final review and inclusion in this study. RESULTS Among 45 shoulder specialists across different studies, interrater agreement for Goutallier staging with use of magnetic resonance imaging (MRI) ranged from 0.24 to 0.82 and intrarater agreement for supraspinatus fatty changes ranged from 0.34 to 0.89. Our review also showed strong positive correlations when assessing the severity of fatty atrophy of the rotator cuff between MRI and ultrasound or ultrasound modalities such as sonoelastography. CONCLUSIONS Increasing fatty infiltration of the rotator cuff is associated with greater repair failure rates and hence poorer overall clinical outcomes. MRI remains the gold standard for the imaging of rotator cuff tears and postoperative healing. Ultrasound can decrease health-care expenditures associated with the assessment of repair integrity postoperatively, although ultrasound is not as precise and has some limitations compared with MRI.
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Affiliation(s)
- Troy N Tenbrunsel
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - James D Whaley
- Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - David Golchian
- Department of Orthopaedic Surgery, Beaumont Health, Taylor, Michigan
| | - Danielle L Malone
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Diego J L Lima
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Vani J Sabesan
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
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Prado-Costa R, Rebelo J, Monteiro-Barroso J, Preto AS. Ultrasound elastography: compression elastography and shear-wave elastography in the assessment of tendon injury. Insights Imaging 2018; 9:791-814. [PMID: 30120723 PMCID: PMC6206379 DOI: 10.1007/s13244-018-0642-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/22/2018] [Accepted: 06/21/2018] [Indexed: 12/27/2022] Open
Abstract
Ultrasound elastography (USE) is a recent technology that has experienced major developments in the past two decades. The assessment of the main mechanical properties of tissues can be made with this technology by characterisation of their response to stress. This article reviews the two major techniques used in musculoskeletal elastography, compression elastography (CE) and shear-wave elastography (SWE), and evaluates the studies published on major electronic databases that use both techniques in the context of tendon pathology. CE accounts for more studies than SWE. The mechanical properties of tendons, particularly their stiffness, may be altered in the presence of tendon injury. CE and SWE have already been used for the assessment of Achilles tendons, patellar tendon, quadriceps tendon, epicondylar tendons and rotator cuff tendons and muscles. Achilles tendinopathy is the most studied tendon injury with USE, including the postoperative period after surgical repair of Achilles rupture tendon. In relation to conventional ultrasound (US), USE potentially increases the sensitivity and diagnostic accuracy in tendinopathy, and can detect pathological changes before they are visible in conventional US imaging. Several technical limitations are recognised, and standardisation is necessary to ensure repeatability and comparability of the results when using these techniques. Still, USE is a promising technique under development and may be used not only to promote an early diagnosis, but also to identify the risk of injury and to support the evaluation of rehabilitation interventions. KEY POINTS: • USE is used for the assessment of the mechanical properties of tissues, including the tendons. • USE increases diagnostic performance when coupled to conventional US imaging modalities. • USE will be useful in early diagnosis, tracking outcomes and monitoring treatments of tendon injury. • Technical issues and lack of standardisation limits USE use in the assessment of tendon injury.
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Affiliation(s)
- Rui Prado-Costa
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Rebelo
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal.
| | - João Monteiro-Barroso
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Sofia Preto
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal
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Seo JB, Yoon SH, Lee JY, Kim JK, Yoo JS. What Is the Most Effective Eccentric Stretching Position in Lateral Elbow Tendinopathy? Clin Orthop Surg 2018; 10:47-54. [PMID: 29564047 PMCID: PMC5851854 DOI: 10.4055/cios.2018.10.1.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/08/2017] [Indexed: 01/06/2023] Open
Abstract
Background A variety of treatment options suggest that the optimal treatment strategy for lateral elbow tendinopathy (LET) is not known, and further research is needed to discover the most effective treatment for LET. The purpose of the present study was to verify the most effective position of eccentric stretching for the extensor carpi radialis brevis (ECRB) in vivo using ultrasonic shear wave elastography. Methods A total of 20 healthy males participated in this study. Resting position was defined as 90° elbow flexion and neutral position of the forearm and wrist. Elongation of the ECRB was measured for four stretching maneuvers (forearm supination/pronation and wrist extension/flexion) at two elbow angles (90° flexion and full extension). The shear elastic modulus, used as the index of muscle elongation, was computed using ultrasonic shear wave elastography for the eight aforementioned stretching maneuverangle combinations. Results The shear elastic modulus was the highest in elbow extension, forearm pronation, and wrist flexion. The shear elastic moduli of wrist flexion with any forearm and elbow position were significantly higher than the resting position. There was no significant difference associated with elbow and forearm positions except for elbow extension, forearm pronation, and wrist flexion positions. Conclusions This study determined that elbow extension, forearm pronation, and wrist flexion was the most effective eccentric stretching for the ECRB in vivo.
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Affiliation(s)
- Joong-Bae Seo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Sung-Hyun Yoon
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Joon-Yeul Lee
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jun-Kyom Kim
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jae-Sung Yoo
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
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Ultrasound elastography-based assessment of the elasticity of the supraspinatus muscle in impingement syndrome: does elastography has any diagnostic value? Clin Rheumatol 2018; 37:1661-1665. [PMID: 29313270 DOI: 10.1007/s10067-017-3928-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/15/2017] [Accepted: 11/21/2017] [Indexed: 12/22/2022]
Abstract
Ultrasound elastography (UE) is a new ultrasound-based imaging technique that provides information about elasticity and stiffness of tissues. This cross-sectional study aimed to identify the diagnostic importance of UE in supraspinatus impingement syndrome. Forty-one subjects, aged 38-70 years, were included in the study. UE was used to determine the elasticity of the supraspinatus muscle. The strain ratio was calculated as the evaluation criteria to measure the elasticity of the muscle. High strain ratio indicated low elasticity. The measurements were made by the blinded radiologist while the patients sat with their shoulder in a neutral position. The diagnostic value of the strain ratio was evaluated using the receiver operating characteristic (ROC) analysis. The mean strain value of the supraspinatus muscle on the intact and pathological shoulders determined by UE was 0.74 ± 0.33 and 0.31 ± 0.24, respectively. A low strain ratio value in the supraspinatus muscle on the side with impingement syndrome was measured. When the test variable was evaluated as "strain ratio" according to ROC curve analysis, it was found to be above the reference line [0.849 (> 0.5)] (P = 0.00). When the cutoff value was selected as 0.495, the sensitivity and specificity were found to be 75.6 and 78% (the strain ratio value > 0.495), respectively. Measurement of strain ratio with UE can be used as a noninvasive, inexpensive, and practical diagnostic test for the shoulder impingement disease.
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Gilbert F, Klein D, Weng AM, Köstler H, Schmitz B, Schmalzl J, Böhm D. Supraspinatus muscle elasticity measured with real time shear wave ultrasound elastography correlates with MRI spectroscopic measured amount of fatty degeneration. BMC Musculoskelet Disord 2017; 18:549. [PMID: 29282062 PMCID: PMC5745767 DOI: 10.1186/s12891-017-1911-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/13/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Fatty Degeneration (FD) of the rotator cuff muscles influences functional and anatomical outcome after rotator cuff repair. The MRI based estimation of fatty degeneration is the gold standard. There is some evidence that Ultrasound elastography (EUS) can detect local differences of tissue stiffness in muscles and tendons. Shear-wave elastography (SWE) was evaluated to determine the extent to which shear wave velocity was associated with measures of fatty degeneration. MRI-spectroscopic fat measurement was used as a reference to quantify the amount of fat in the muscle belly. METHODS Forty-two patients underwent SWE of the supraspinatus muscles at its thickest diameter. After ultrasound evaluation an MRI-spectroscopic fat measurement of the supraspinatus muscle was performed using the SPLASH-technique. A gel filled capsule was used to locate the measured area in the MRI. The values of shear wave velocity (SWV) measured with SWE and spectroscopic fat measurement were correlated statistically using Pearson's correlation test. RESULTS Correlation of the fat amount measured with MRI-spectroscopy and the SWV measured with SWE was ρ =0.82. Spectroscopic measured fat ratio of the supraspinatus muscle ranged from 0% to 77.41% and SWV from 1.59 m/s to 5.32 m/s. In 4 patients no sufficient SWE could be performed, these individuals showed a larger diameter of the overlying soft tissue. SWV measured with SWE showed a good correlation with MRI spectroscopic fat amount of the supraspinatus muscle. CONCLUSION These preliminary data suggest that SWE may be a sufficient tool in detecting and estimating the amount of fatty degeneration in the supraspinatus muscle in real time. Large overlying soft tissue may be a limitation in performing sufficient EUS. Ethical Committee Approval: Nr: 156/14 Date 12th August 2014. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Oberduerrbacherstr. 6, D-97080 Wuerzburg, Germany
| | - Detlef Klein
- Department of Radiology, Julius-Maximilians-University of Wuerzburg, Oberduerrbacherstr. 6, D-97080 Wuerzburg, Germany
| | - Andreas Max Weng
- Department of Radiology, Julius-Maximilians-University of Wuerzburg, Oberduerrbacherstr. 6, D-97080 Wuerzburg, Germany
| | - Herbert Köstler
- Department of Radiology, Julius-Maximilians-University of Wuerzburg, Oberduerrbacherstr. 6, D-97080 Wuerzburg, Germany
| | - Benedikt Schmitz
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Oberduerrbacherstr. 6, D-97080 Wuerzburg, Germany
| | - Jonas Schmalzl
- Ortho Mainfranken Wuerzburg, Bismarckstraße 16, D-97080 Wuerzburg, Germany
| | - Dirk Böhm
- Ortho Mainfranken Wuerzburg, Bismarckstraße 16, D-97080 Wuerzburg, Germany
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Rosskopf AB, Ehrmann C, Buck FM, Gerber C, Flück M, Pfirrmann CWA. Quantitative Shear-Wave US Elastography of the Supraspinatus Muscle: Reliability of the Method and Relation to Tendon Integrity and Muscle Quality. Radiology 2015; 278:465-74. [PMID: 26540450 DOI: 10.1148/radiol.2015150908] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the reliability of ultrasonographic (US) elastography of the supraspinatus (SSP) muscle, define normal shear-wave velocity (SWV) values, and correlate findings with tendon integrity and muscle quality. MATERIALS AND METHODS The study was approved by the local ethics committee, and written informed consent was obtained from all patients. SSP SWV (in meters per second) was prospectively assessed twice in 22 asymptomatic volunteers (mean age ± standard deviation, 53.8 years ± 15.3; 11 women and 11 men) by two independent examiners by using shear-wave elastography. Forty-four patients (mean age, 51.9 years ± 15.0; 22 women and 22 men) were prospectively included. SWV findings were compared with tendon integrity, tendon retraction (Patte classification), fatty muscle infiltration (Goutallier stages 0-IV), and muscle volume atrophy (tangent sign) on magnetic resonance (MR) images. Descriptive statistics, Spearman correlation, analysis of variance, two-sample t test, and intraclass correlation coefficient (ICC) were used. RESULTS Test-retest reliability for mean total SWV (MTSWV) was good for examiner 1 (ICC = 0.70; 95% confidence interval [CI]: 0.30, 0.87; P = .003) and excellent for examiner 2 (ICC = 0.80; 95% CI: 0.53, 0.92; P < .001). Interexaminer reliability was excellent (ICC = 0.89; 95% CI: 0.64, 0.96; P < .001). MTSWV in volunteers (3.0 m/sec ± 0.5) was significantly higher than that in patients (2.5 m/sec ± 0.5; P = .001). For tendon integrity, no significant difference in MTSWV was found. For tendon retraction, MTSWV varies significantly between patients with different degrees of retraction (P = .047). No significant differences were found for Goutallier subgroups. MTSWV was significantly lower with a positive tangent sign (P = .015; n = 10). CONCLUSION Shear-wave elastography is reproducible for assessment of the SSP muscle. Mean normal SSP SWV is 3.0 m/sec ± 0.5. SWV decreases with increasing fat content (Goutallier stage 0-III) and increases in the final stage of fatty infiltration (Goutallier stage IV).
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Affiliation(s)
- Andrea B Rosskopf
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Christine Ehrmann
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Florian M Buck
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Christian Gerber
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Martin Flück
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
| | - Christian W A Pfirrmann
- From the Departments of Radiology (A.B.R., C.E., F.M.B., C.W.A.P.), Orthopedic Surgery (C.G.), and Orthopedic Research (M.F.), Orthopedic University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland; and University of Zurich, Faculty of Medicine, Zurich, Switzerland (A.B.R., C.E., F.M.B., C.G., M.F., C.W.A.P.)
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Konrads C, Reichel T, Rudert M, Plumhoff P. [Diagnostic sonography for assessment of shoulder pain]. MMW Fortschr Med 2015; 157:73-5. [PMID: 26985515 DOI: 10.1007/s15006-015-3672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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