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Brown J, Kearns G, Hedges E, Samaniego S, Wang-Price S. Blood Flow of the Infraspinatus Muscle in Individuals With and Without Shoulder Pain and Myofascial Trigger Points: A Color Doppler Ultrasound and Reliability Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2025; 44:127-136. [PMID: 39360549 DOI: 10.1002/jum.16590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/26/2024] [Accepted: 09/18/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVES Myofascial trigger points (MTrPs) are potential contributors to shoulder pain and can lead to local ischemia and hypoxia, thus causing pain. Color Doppler ultrasound (US) has been used to examine the vascular environment around MTrPs, but has not been used to examine blood flow impairments in patients with shoulder pain and MTrPs. The reliability of color Doppler US for measuring infraspinatus muscle blood flow also has not been established. This study aimed to investigate differences in blood flow between individuals with and without shoulder pain and the reliability of Doppler US for measuring infraspinatus muscle blood flow. METHODS Forty participants were enrolled, 20 with shoulder pain and MTrPs and 20 without. Color Doppler US examination was performed twice on each participant to measure peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and pulsatile index (PI) of the infraspinatus muscle. RESULTS The symptomatic participants had significantly higher PSV (ie, impaired blood flow) than the asymptomatic participants. There were no significant between-group differences in EDV, RI, and PI. The results also demonstrated good-to-excellent intra-rater reliability for color Doppler US measurements of PSV, EDV, RI, and PI for both groups. CONCLUSION This study demonstrated differences in blood flow near MTrPs in the infraspinatus muscle between individuals with and without shoulder pain. It also established good-to-excellent reliability of color Doppler US in measuring infraspinatus muscle blood flow. These findings suggest color Doppler US is a useful tool to identify vascular impairments for shoulder pain associated with MTrPs.
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Affiliation(s)
- Jace Brown
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Gary Kearns
- Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Emily Hedges
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Samantha Samaniego
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman's University, Dallas, Texas, USA
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Liu X, Yang Y, Jia J. Respiratory muscle ultrasonography evaluation and its clinical application in stroke patients: A review. Front Neurosci 2023; 17:1132335. [PMID: 37090789 PMCID: PMC10115993 DOI: 10.3389/fnins.2023.1132335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Background Respiratory muscle ultrasound is a widely available, highly feasible technique that can be used to study the contribution of the individual respiratory muscles related to respiratory dysfunction. Stroke disrupts multiple functions, and the respiratory function is often significantly decreased in stroke patients. Method A search of the MEDLINE, Web of Science, and PubMed databases was conducted. We identified studies measuring respiratory muscles in healthy and patients by ultrasonography. Two reviewers independently extracted and documented data regarding to the criteria. Data were extracted including participant demographics, ultrasonography evaluation protocol, subject population, reference values, etc. Result A total of 1954 participants from 39 studies were included. Among them, there were 1,135 participants from 19 studies on diaphragm, 259 participants from 6 studies on extra-diaphragmatic inspiratory muscles, and 560 participants from 14 studies on abdominal expiratory muscles. The ultrasonic evaluation of diaphragm and abdominal expiratory muscle thickness had a relatively typically approach, while, extra-diaphragmatic inspiratory muscles were mainly used in ICU that lack of a consistent paradigm. Conclusion Diaphragm and expiratory muscle ultrasound has been widely used in the assessment of respiratory muscle function. On the contrary, there is not enough evidence to assess extra-diaphragmatic inspiratory muscles by ultrasound. In addition, the thickness of the diaphragm on the hemiplegic side was lower than that on the non-hemiplegic side in stroke patients. For internal oblique muscle (IO), rectus abdominis muscle (RA), transversus abdominis muscle (TrA), and external oblique muscle (EO), most studies showed that the thickness on the hemiplegic side was lower than that on the non-hemiplegic side.Clinical Trial Registration: The protocol of this review was registered in the PROSPERO database (CRD42022352901).
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Affiliation(s)
- Xiaoman Liu
- Department of Rehabilitation Medicine, The People’s Hospital of Suzhou New District, Suzhou, China
| | - Ying Yang
- Department of Rehabilitation Medicine, The People’s Hospital of Suzhou New District, Suzhou, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Fudan University Huashan Hospital, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Fudan University Huashan Hospital, Shanghai, China
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Chen W, Zhang X, Xu Y, Xu Z, Qin H, Zhang L. Ultrasound-guided five-point injection of botulinum toxin for patients with trapezius hypertrophy. J Orthop Surg Res 2021; 16:634. [PMID: 34686203 PMCID: PMC8532279 DOI: 10.1186/s13018-021-02758-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Our study aimed to explore the clinical therapeutic effects of ultrasound-guided five-point injection of botulinum toxin type A for patients with trapezius hypertrophy. METHODS Twenty female patients diagnosed with trapezius hypertrophy were enrolled in this study. The thicknesses of the trapezius muscle were measured by using the ultrasound scanner to locate the thickest point of trapezius, followed by labelling the other four points around the first point. Botulinum toxin type A was injected bilaterally (50 IU/side, 5 points/side) in the trapezius muscle of these patients. The surgery effects were evaluated by thicknesses of the trapezius muscle, intramuscular needle electromyographic and electroneurographic examinations, appearance changes and patients' satisfactions. RESULTS Statistically significant differences in thicknesses of the trapezius muscle were observed at 4 weeks (p < 0.001), 12 weeks (p < 0.001), 20 weeks (p < 0.001), 28 weeks (p = 0.011), 36 weeks (p = 0.022), and 44 weeks (p = 0.032) after surgery. The latencies of trapezius muscle became longer at 12 weeks after surgery (left: 2.40 ms, right: 2.53 ms vs. left: 1.75 ms, right: 2.00 ms). Electroneurographic results showed amplitude reduction of compound muscle action potentials (CMAPs) at 12 weeks after surgery (left: 1.91 uV, right: 3.10 uV vs. left: 15.00 uV, right: 15.40 uV). Obvious appearance changes were revealed at 12 weeks after surgery. All of 80% patients were very satisfied, 15% patients were relatively satisfied, and 5% patients were not satisfied with the surgery. CONCLUSION Ultrasound-guided five-point injection of botulinum toxin type A might be effective for patients with trapezius hypertrophy.
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Affiliation(s)
- Wanying Chen
- Department of Plastic Surgery, The Third Hospital of Jilin University, No.126, Xiantai Street, Erdao District, Changchun, 130000 Jilin China
| | - Xiaoyu Zhang
- Department of Gastrointestinal and Colorectal Surgery, The Third Hospital of Jilin University, Changchun, 130000 Jilin China
| | - Yingying Xu
- Department of Ultrasound, The Third Hospital of Jilin University, Changchun, 130000 Jilin China
| | - Zemin Xu
- Orthopedics Department, The Third Hospital of Jilin University, Changchun, 130000 Jilin China
| | - Haiyan Qin
- Department of Plastic Surgery, The Third Hospital of Jilin University, No.126, Xiantai Street, Erdao District, Changchun, 130000 Jilin China
| | - Lianbo Zhang
- Department of Plastic Surgery, The Third Hospital of Jilin University, No.126, Xiantai Street, Erdao District, Changchun, 130000 Jilin China
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Silkjær Bak S, Johnsen B, Fuglsang-Frederiksen A, Døssing K, Qerama E. Neuromuscular ultrasound of the scapular stabilisers in healthy subjects. Clin Neurophysiol Pract 2021; 6:72-80. [PMID: 33732970 PMCID: PMC7937536 DOI: 10.1016/j.cnp.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 12/29/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022] Open
Abstract
HRUS can be used to visualise the muscles stabilizing the scapula and their corresponding nerves. We found acceptable intra- and inter-examiner agreements. We present HRUS normative data using regression-based prediction formulas. To our knowledge, we present the first-time normative data of diameter of the dorsal scapular nerve.
Objectives To obtain normative high-resolution ultrasound (HRUS) data for thickness of the serratus anterior, the trapezius and the rhomboid major muscles and diameter of their corresponding nerves, the long thoracic, the spinal accessory and the dorsal scapular nerve. Moreover, we aimed to examine intra- and inter-examiner agreement of the HRUS measurements. Methods We included 41 healthy subjects. Muscle thickness and nerve diameter were measured bilaterally, resulting in 82 ultrasound measurements for each structure. Normative data were calculated using regression equations for the lower limit of muscle thickness and upper limit of nerve diameter, taking into account various variables. For intra- and inter-examiner agreement, ten subjects underwent two extra ultrasound examinations and Bland-Altman plots were calculated. Results This normative data set showed significant correlations between decreasing muscle thickness with increasing age and height and increasing muscle thickness with increasing weight and with male sex. Muscle thickness was larger on the dominant side compared to the non-dominant side for the trapezius and rhomboid muscles, whereas the opposite was found for the serratus anterior muscle. For all nerves, significant correlations were found between decreasing nerve diameter with increasing age and height. Intra-examiner agreement was acceptable in all sites. Inter-examiner agreement was acceptable for all sites but one site for the serratus anterior muscle and long thoracic nerve, and not acceptable for five out of six sites for the trapezius muscle. Conclusion This study provides HRUS normative data and intra- and inter-examiner agreement data for muscle thickness and nerve diameter for the muscles stabilizing the scapulae and their corresponding nerves. Significance The normative HRUS data reported may be useful in future studies investigating neuromuscular disorders.
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Affiliation(s)
- Sara Silkjær Bak
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark
| | - Birger Johnsen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
| | - Anders Fuglsang-Frederiksen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
| | - Kaj Døssing
- Department of Orthopaedics, Viborg Regional Hospital, Heibergs Alle 4F Indgang F, Etage 3, 8800 Viborg, Denmark
| | - Erisela Qerama
- Department of Clinical Neurophysiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 16, Plan 2, J209, DK-8200 Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 82, Incuba/Skejby, Building 2, DK-8200 Aarhus N, Denmark
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Wang L, Xiang X, Zhu BH, Qiu L. Determination of reference ranges for normal upper trapezius elasticity during different shoulder abduction using shear wave elastography: a preliminary study. Sci Rep 2020; 10:17104. [PMID: 33051541 PMCID: PMC7555503 DOI: 10.1038/s41598-020-74307-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to determine the reference ranges of normal upper trapezius (UT) elasticity during different shoulder abduction using shear wave elastography (SWE). Mean shear wave velocity (SWV) of UT elasticity in eighty healthy participants were measured at left and right shoulder 0° abduction and 90° passive abduction (L0°, R0°, L90°, R90°) with SWE. The effects of potential factors (gender, UT thickness, age, and body mass index) on UT elasticity were analyzed. The reference ranges of normal UT elasticity were calculated by using the normal distribution method. UT elasticity was significantly different among various shoulder abduction (P < 0.0001). UT elasticity was significantly higher in males at both L90° (P < 0.05) and R90° (P < 0.01) than in females. The reference ranges of normal UT elasticity were 2.90-4.01 m/s at L0° and 3.01-4.29 m/s at R0°, and were 4.90-6.40 m/s in males and 4.40-6.20 m/s in females at L90°, 5.20-7.02 m/s in males and 4.71-6.80 m/s in females at R90°. Our results suggest that gender should be considered when determining the reference ranges of normal UT elasticity at L90° and R90° with SWE. These values may provide quantitative baseline measurements for the assessment of UT muscle strain in the future.
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Affiliation(s)
- Lei Wang
- Department of Ultrasound, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.,Department of Ultrasound, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, Sichuan Province, China
| | - Xi Xiang
- Department of Ultrasound, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Bi-Hui Zhu
- Department of Ultrasound, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
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Alburquerque-Sendín F, Madeleine P, Fernández-de-Las-Peñas C, Camargo PR, Salvini TF. Spotlight on topographical pressure pain sensitivity maps: a review. J Pain Res 2018; 11:215-225. [PMID: 29403305 PMCID: PMC5779713 DOI: 10.2147/jpr.s135769] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Mechanical hyperalgesia defined as decreased pressure pain thresholds (PPTs) is commonly associated with pain. In this narrative review, we report the current state of the art within topographical pressure sensitivity maps. Such maps are based on multiple PPT assessments. The PPTs are assessed by an a priori defined grid with special focus on both spatial and temporal summation issues. The grid covers the muscle or the body region of interest using absolute or relative values determined from anatomical landmarks or anthropometric values. The collected PPTs are interpolated by Shepard or Franke and Nielson interpolation methods to create topographical pressure sensitivity maps. This new imaging technique has proven to be valuable in various disciplines including exercise physiology, neurology, physical therapy, occupational medicine, oncology, orthopedics, and sport sciences. The reviewed papers have targeted different body regions like the scalp, low back, neck-shoulder, and upper and lower extremities. The maps have delineated spatial heterogeneity in the pressure pain sensitivity underlining the different extents of pressure pain hyperalgesia in both experimentally induced and disease-associated pain conditions. Furthermore, various intervention studies have proven the utility of topographical pressure pain sensitivity maps. Topographical pressure pain sensitivity maps have contributed to revealing the efficacy of therapeutic, ergonomic, or training interventions that aim at reducing pain.
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Affiliation(s)
| | - Pascal Madeleine
- Physical Activity and Human Performance Group, SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain
| | - Paula Rezende Camargo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Tania Fátima Salvini
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
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