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Cebula A, Cebula M, Czajkowska M, Gruszczyńska K, Kopyta I. Influence of the physical pressure of an ultrasound probe on shear-wave elastography measurements of the gastrocnemius muscle in a paediatric population: a non-interventional cohort study. Pol J Radiol 2024; 89:e24-e29. [PMID: 38371890 PMCID: PMC10867979 DOI: 10.5114/pjr.2024.134437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/15/2023] [Indexed: 02/20/2024] Open
Abstract
Purpose The aim of our study is to evaluate the impact of ultrasound probe mechanical pressure on the stiffness of the gastrocnemius muscle in a healthy paediatric population. As far as we know, there has been no previous qualitative in vivo study on the impact of probe pressure on muscle shear-wave elastography results with objective evaluation of compression in the paediatric population. Material and methods In this cohort study, a group of 22 children (mean age 8.99 years, SD 2.74, 11 males) underwent elastography of the gastrocnemius muscle of the dominant leg. A custom-made, 3-dimensional printed probe cover was used to measure the mechanical pressure of the probe on tissues. Results The obtained results were related to the age, sex, BMI, and calf circumference of the subjects. We observed a significant difference in the stiffness parameter at a pressure of 1 N, with a further increase if force was increased (p < 0.001). A significant, very weak positive correlation of age and stiffness was observed (p < 0.001, r2 = 0.022). There was no significant correlation of stiffness, BMI, and calf circumference. Conclusions The use of compression during muscle elastography in children causes a significant bias in results, regardless of age, sex, BMI, or calf size.
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Affiliation(s)
- Agnieszka Cebula
- Department of Paediatric Neurology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Poland
| | - Maciej Cebula
- Individual Specialist Medical Practice Maciej Cebula, Katowice, Poland
| | - Marta Czajkowska
- Doctoral School, Medical University of Silesia in Katowice, Poland
| | - Katarzyna Gruszczyńska
- Department of Radiology and Nuclear Medicine, Faculty of Medicine, Medical University of Silesia in Katowice, Poland
| | - Ilona Kopyta
- Department of Paediatric Neurology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Poland
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Kaya Keles CS, Ates F. How mechanics of individual muscle-tendon units define knee and ankle joint function in health and cerebral palsy-a narrative review. Front Bioeng Biotechnol 2023; 11:1287385. [PMID: 38116195 PMCID: PMC10728775 DOI: 10.3389/fbioe.2023.1287385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
This study reviews the relationship between muscle-tendon biomechanics and joint function, with a particular focus on how cerebral palsy (CP) affects this relationship. In healthy individuals, muscle size is a critical determinant of strength, with muscle volume, cross-sectional area, and moment arm correlating with knee and ankle joint torque for different isometric/isokinetic contractions. However, in CP, impaired muscle growth contributes to joint pathophysiology even though only a limited number of studies have investigated the impact of deficits in muscle size on pathological joint function. As muscles are the primary factors determining joint torque, in this review two main approaches used for muscle force quantification are discussed. The direct quantification of individual muscle forces from their relevant tendons through intraoperative approaches holds a high potential for characterizing healthy and diseased muscles but poses challenges due to the invasive nature of the technique. On the other hand, musculoskeletal models, using an inverse dynamic approach, can predict muscle forces, but rely on several assumptions and have inherent limitations. Neither technique has become established in routine clinical practice. Nevertheless, identifying the relative contribution of each muscle to the overall joint moment would be key for diagnosis and formulating efficient treatment strategies for patients with CP. This review emphasizes the necessity of implementing the intraoperative approach into general surgical practice, particularly for joint correction operations in diverse patient groups. Obtaining in vivo data directly would enhance musculoskeletal models, providing more accurate force estimations. This integrated approach can improve the clinicians' decision-making process and advance treatment strategies by predicting changes at the muscle and joint levels before interventions, thus, holding the potential to significantly enhance clinical outcomes.
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Nakamura S, Kimoto M, Okada K, Kawanobe U, Sakamoto H. Impact of lower muscle stiffness on ankle dorsiflexion restriction in children with cerebral palsy evaluated using ultrasound elastography. Clin Biomech (Bristol, Avon) 2023; 109:106092. [PMID: 37738919 DOI: 10.1016/j.clinbiomech.2023.106092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Plantar flexor muscles always contribute to limiting the range of motion of ankle dorsiflexion in children with spastic cerebral palsy, but the individual contributions of these muscles are not well defined. This study aimed to identify which muscles' stiffness impacts the dorsiflexion range of motion in children with cerebral palsy. METHODS Twenty-five children with cerebral palsy were included. The maximum passive dorsiflexion range of motion was measured in two positions: hip and knee joints in flexion, and both joints in full extension. Strain ratios indicating muscle stiffness were measured using strain elastography of the lateral and medial gastrocnemius, soleus, flexor hallucis longus, peroneus longus, peroneus brevis, and tibialis posterior muscles. To analyze which muscles impact the limitation of the dorsiflexion range, multiple regression analyses were conducted. The values of muscle stiffness were included as independent valuables, and the values of the dorsiflexion range were included as dependent valuables. A p-value <0.05 was considered statistically significant. FINDINGS In the analyses, the soleus and flexor hallucis longus muscle stiffness were significant independent factors for the dorsiflexion range of motion of hip and knee flexion (adjusted R2: 0.50). The lateral gastrocnemius muscle stiffness was a significant independent factor for the dorsiflexion range of motion with both joints in full extension (adjusted R2: 0.61). INTERPRETATION Flexor hallucis longus muscle stiffness, in addition to triceps surae muscle stiffness, was shown to impact dorsiflexion range; attention should be paid to muscle stiffness in children with cerebral palsy.
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Affiliation(s)
- Shinya Nakamura
- Department of Rehabilitation, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita 010-8543, Japan.
| | - Minoru Kimoto
- Department of Rehabilitation, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan; Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Uki Kawanobe
- Department of Rehabilitation, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan
| | - Hitoshi Sakamoto
- Department of Medicine, Akita Prefectural Center on Development and Disability, 1-1-2, Minamigaoka, Akita 010-1409, Japan
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Močnik M, Marčun Varda N. Ultrasound Elastography in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1296. [PMID: 37628295 PMCID: PMC10453784 DOI: 10.3390/children10081296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Ultrasound elastography is a novel ultrasound technique, being extensively researched in children in the last decade. It measures tissue elasticity with the observation of tissue response after an external stimulus. From research to clinical practice, ultrasound elastography has evolved significantly in liver fibrosis evaluation in children; however, several other applications of the technique are available in both clinical practice and research environments. Practically, in children any organ can be assessed, including the brain in early ages, along with muscle and connective tissue elasticity evaluation, spleen, kidney, skin, lymphatic tissue, etc. The elastography method, age, body mass index and technical points should be considered when performing ultrasound elastography. This review highlights its vast potential as a diagnostic tool in the pediatric population, where ultrasound is a dominant imaging tool; however, the indications and exam protocol for its clinical use in several fields in pediatrics have yet to be elucidated.
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Affiliation(s)
- Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia;
| | - Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, 2000 Maribor, Slovenia;
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
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Shear Wave Velocity to Evaluate the Effect of Botulinum Toxin on Post-Stroke Spasticity of the Lower Limb. Toxins (Basel) 2022; 15:toxins15010014. [PMID: 36668834 PMCID: PMC9865964 DOI: 10.3390/toxins15010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Background: The evaluation of muscles with spasticity using ultrasound elastography has attracted attention recently, and the shear wave velocity (SWV) technique can measure the mechanical properties of tissues objectively and quantitatively. The purpose of this study was to evaluate the effect of using SWV to assess the effect of Botulinum toxin type A (BoNT-A) treatment in adult patients with post-stroke lower limb spasticity. (2) Methods: We assessed the modified Ashworth Scale, the modified Tardieu Scale, and SWV at rest and after stretching before and at 1 month after BoNT-A treatment in 10 adult participants with post-stroke lower limb spasticity. (3) Results: Significant changes in SWV of the ankle joint in maximum dorsiflexion to the extent possible (SWV stretched) were observed after BoNT-A treatment. SWV stretched was positively correlated with joint range of motion. Participants whose joint range of motion did not improve (i.e., gastrocnemius medialis muscle (GCM) extension distance did not change) had significantly more reductions in SWV stretched after BoNT-A treatment. (4) Conclusions: Our results suggest that the SWV measurements may serve as a quantitative assessment to determine the effect of the BoNT-A treatment in adult stroke patients. SWV measurements to assess GCM spasticity should consider the effects of tension, material properties and activation level of muscles. The challenge is to measure SWV with matching limb positions in patients without contractures.
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Botulinum Toxin Intervention in Cerebral Palsy-Induced Spasticity Management: Projected and Contradictory Effects on Skeletal Muscles. Toxins (Basel) 2022; 14:toxins14110772. [PMID: 36356022 PMCID: PMC9692445 DOI: 10.3390/toxins14110772] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Spasticity, following the neurological disorder of cerebral palsy (CP), describes a pathological condition, the central feature of which is involuntary and prolonged muscle contraction. The persistent resistance of spastic muscles to stretching is often followed by structural and mechanical changes in musculature. This leads to functional limitations at the respective joint. Focal injection of botulinum toxin type-A (BTX-A) is effectively used to manage spasticity and improve the quality of life of the patients. By blocking acetylcholine release at the neuromuscular junction and causing temporary muscle paralysis, BTX-A aims to reduce spasticity and hereby improve joint function. However, recent studies have indicated some contradictory effects such as increased muscle stiffness or a narrower range of active force production. The potential of these toxin- and atrophy-related alterations in worsening the condition of spastic muscles that are already subjected to changes should be further investigated and quantified. By focusing on the effects of BTX-A on muscle biomechanics and overall function in children with CP, this review deals with which of these goals have been achieved and to what extent, and what can await us in the future.
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Cebula A, Cebula M, Kopyta I. Muscle Ultrasonographic Elastography in Children: Review of the Current Knowledge and Application. CHILDREN 2021; 8:children8111042. [PMID: 34828755 PMCID: PMC8623756 DOI: 10.3390/children8111042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
Ultrasonographic elastography is a relatively new imaging modality for the qualitative and quantitative assessments of tissue elasticity. While it has steadily gained use in adult clinical practice, including for liver diseases, breast cancer, thyroid pathologies, and muscle and tendon diseases, data on its paediatric application is still limited. Moreover, diagnosis of muscular diseases in children remains challenging. The gold standard methods, namely biopsy, electroneurography, and electromyography, are often limited owing to their invasive characteristics, possible contraindications, complications, and need for good cooperation, that is, a patient’s ability to perform certain tasks during the examination while withstanding discomfort, which is a significant problem especially in younger or uncooperative children. Genetic testing, which has broad diagnostic possibilities, often entails a high cost, which limits its application. Thus, a non-invasive, objective, repeatable, and accessible tool is needed to aid in both the diagnosis and monitoring of muscle pathologies. We believe that elastography may prove to be such a method. The aim of this review was to present the current knowledge on the use of muscle elastography in the paediatric population and information on the limitations of elastography in relation to examination protocols and factors for consideration in everyday practice and future studies.
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Affiliation(s)
- Agnieszka Cebula
- Department of Paediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Str 16, 40-752 Katowice, Poland;
- Correspondence: ; Fax: +48-322071546
| | - Maciej Cebula
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, Faculty of Medicine in Katowice, Medical University of Silesia in Katowice, Medykow Str 14, 40-752 Katowice, Poland;
| | - Ilona Kopyta
- Department of Paediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Str 16, 40-752 Katowice, Poland;
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Barun B, Barišić I, Krnić A, Benzon B, Vlak T, Aljinović J. Neck Disability Index Is Better in Classification of Recovery after Whiplash Injury in Comparison with Ultrasound Shear Wave Elastography of Trapezius Muscle. Diagnostics (Basel) 2021; 11:diagnostics11112077. [PMID: 34829424 PMCID: PMC8622903 DOI: 10.3390/diagnostics11112077] [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] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 12/04/2022] Open
Abstract
A prospective observational study comparing shear wave elastography (SWE) of trapezius muscle with Neck Disability Index (NDI) in a prediction model of health status six months after a whiplash injury. Both SWE values, measured by two radiologists, and NDI scores were obtained at baseline and after physical therapy (PT) (6-month period). Those values were compared with a 3-point Likert scale (no, partial or full recovery). Twenty-two subjects completed the study. A decrease in trapezius stiffness was detected by both radiologists, statistically significant for one (Δ10.1 kPa; p = 0.04) but not for the second radiologist (Δ8.63 kPa; p = 0.07). The measurements showed excellent intra-observer (ICC 0.75–0.94) and inter-observer (ICC 0.78–0.88) reliability. After six months, fully recovered patients showed lower NDI scores than partially recovered patients (Δ22.98; p < 0.001). SWE values did not differ with the recovery status (55.6 ± 9.7 vs. 57 ± 15.8, Δ1.45; p = 0.82). The single most accurate variable in classifying health status six months after whiplash injury was the relative change of NDI, and it showed the highest accuracy (73.9%) and low Akaike information criterion (AIC = 39.2). Overall, the most accurate classification was obtained when combining NDI and SWE after physical therapy with an accuracy of 77.3% and a decrease in AIC (32.8).
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Affiliation(s)
- Blaž Barun
- Institute of Physical and Rehabilitation Medicine with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (T.V.)
| | - Igor Barišić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia; (I.B.); (A.K.)
| | - Ana Krnić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia; (I.B.); (A.K.)
| | - Benjamin Benzon
- Departments of Anatomy, Histology and Embryology and Neuroscience, School of Medicine, University of Split, 21000 Split, Croatia;
| | - Tonko Vlak
- Institute of Physical and Rehabilitation Medicine with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (T.V.)
- Department of Physical and Rehabilitation Medicine, School of Medicine, University of Split, 21000 Split, Croatia
| | - Jure Aljinović
- Institute of Physical and Rehabilitation Medicine with Rheumatology, University Hospital Split, Šoltanska 1, 21000 Split, Croatia; (B.B.); (T.V.)
- Department for Health Studies, University of Split, 21000 Split, Croatia
- Correspondence:
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Olchowy A, Więckiewicz M, Malysa A, Olchowy C. Determination of Reference Values of the Masseter Muscle Stiffness in Healthy Adults Using Shear Wave Elastography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179371. [PMID: 34501961 PMCID: PMC8430510 DOI: 10.3390/ijerph18179371] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/03/2022]
Abstract
Shear wave elastography (SWE) is an objective and reliable method for the assessment of muscles and internal organs. Every organ exhibits its own stiffness characteristics and hence requires individual reference values. We aimed to determine the reference values of stiffness of the masseter muscle in healthy adult individuals using SWE. We analyzed the data of 140 participants (74 men, 66 women) with a median age of 50 years. The overall mean elasticity was 10.67 ± 1.77 kPa. The average values were lower by 2.25 kPa (9.15%) in women compared to men (9.48 ± 1.47 kPa vs. 11.73 ± 1.27 kPa; p < 0.0001). The values of stiffness increased with age, with a correlation coefficient of about 0.35 and a p < 0.0001. Age was a significant influencing factor of masseter muscle stiffness. The left and right masseters had similar stiffness. We conclude that stiffness values are significantly lower in women than in men with a difference of 9%. Age significantly influences the stiffness of masseter muscle, and the values of stiffness increase significantly with age, particularly in men. However, further studies are required to determine the precise ranges of stiffness accounting for age and sex in healthy subjects and people with disorders and conditions of the masticatory system.
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Affiliation(s)
- Anna Olchowy
- Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.O.); (M.W.); (A.M.)
| | - Mieszko Więckiewicz
- Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.O.); (M.W.); (A.M.)
| | - Andrzej Malysa
- Department of Experimental Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland; (A.O.); (M.W.); (A.M.)
| | - Cyprian Olchowy
- Department of Oral Surgery, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Correspondence:
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