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Boissonnault È, Jeon A, Munin MC, Filippetti M, Picelli A, Haldane C, Reebye R. Assessing muscle architecture with ultrasound: implications for spasticity. Eur J Transl Myol 2024; 34:12397. [PMID: 38818772 PMCID: PMC11264226 DOI: 10.4081/ejtm.2024.12397] [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: 03/04/2024] [Accepted: 04/21/2024] [Indexed: 06/01/2024] Open
Abstract
Botulinum Neurotoxin Type A (BoNT-A) injections using Ultrasound (US) guidance have led to research evaluating changes in muscle architecture. Controversy remains as to what constitutes increased Echo-Intensity (EI) in spastic muscles and whether this may affect outcomes. We aim to provide a narrative review of US muscle architecture changes following Central Nervous System (CNS) lesions and explore their relationship to spasticity. Medline, CINAHL, and Embase databases were searched with keywords: ultrasonography, hypertonia, spasticity, fibrosis, and Heckmatt. Three physicians reviewed the results of the search to select relevant papers. Reviews identified in the search were used as a resource to identify additional studies. A total of 68 papers were included. Four themes were identified, including histopathological changes in spastic muscle, effects of BoNT-A on the muscle structure, available US modalities to assess the muscle, and utility of US assessment in clinical spasticity. Histopathological studies revealed atrophic and fibro-fatty changes after CNS lesions. Several papers described BoNT-A injections contributing to those modifications. These changes translated to increased EI. The exact significance of increased muscle EI remains unclear. The Modified Heckmatt Scale (MHS) is a validated tool for grading muscle EI in spasticity. The use of the US may be an important tool to assess muscle architecture changes in spasticity and improve spasticity management. Treatment algorithms may be developed based on the degree of EI. Further research is needed to determine the incidence and impact of these EI changes in spastic muscles.
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Affiliation(s)
- Ève Boissonnault
- Faculty of Medicine, Université de Montréal, Montreal, Canada; Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston.
| | - April Jeon
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh.
| | - Michael C Munin
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical Medicine and Rehabilitation School of Medicine, University of Pittsburgh School of Medicine, Pittsburgh.
| | - Mirko Filippetti
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical and Rehabilitation Medicine section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Alessandro Picelli
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Physical and Rehabilitation Medicine section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona.
| | - Chloe Haldane
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver.
| | - Rajiv Reebye
- Canadian Advances in Neuro-Orthopedics for Spasticity Consortium (CANOSC), Kingston, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver.
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Miller T, Bello UM, Tsang CSL, Winser SJ, Ying MTC, Pang MYC. Using ultrasound elastography to assess non-invasive, non-pharmacological interventions for musculoskeletal stiffness: a systematic review and meta-analysis. Disabil Rehabil 2023:1-15. [PMID: 37668241 DOI: 10.1080/09638288.2023.2252744] [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: 02/23/2022] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To evaluate the current evidence regarding the use of ultrasound elastography for assessing non-invasive, non-pharmacological interventions for eliciting changes in musculoskeletal stiffness. METHODS A systematic search of MEDLINE, CINAHL, EMBASE, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Information on measurement and intervention procedures was extracted. Bias was assessed using Cochrane Risk of Bias or Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tools for studies with true or quasi-experimental designs, respectively. Analyses were conducted for adequately powered subgroups based on intervention type, measurement site, and population assessed. RESULTS Twenty-one studies were included in the review. Overall risk of bias was low for true experimental studies and moderate for quasi-experimental studies. Subgroup analyses indicated a large overall effect for interventions involving manual physiotherapy and taping/splinting for reducing masseter muscle stiffness in patients with masticatory muscle disorders (g = 1.488, 95% CI = 0.320-2.655, p = 0.013). Analyses for other intervention types and patient groups were underpowered. CONCLUSION Ultrasound elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness. However, the comparative efficacy of these interventions for modulating tissue stiffness remains inconclusive.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Umar M Bello
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Physiotherapy and Paramedicine, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Stanley J Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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Lin MT, Yang SM, Wu HW, Chen YH, Wu CH. Utility of Ultrasound Elastography to Evaluate Poststroke Spasticity and Therapeutic Efficacy: A Narrative Review. J Med Ultrasound 2023; 31:171-177. [PMID: 38025006 PMCID: PMC10668905 DOI: 10.4103/jmu.jmu_106_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/11/2022] [Indexed: 12/01/2023] Open
Abstract
Poststroke spasticity (PSS) is a common complication that affects function and daily self-care. Conservative PSS treatments include traditional rehabilitation, botulinum toxin injection, and extracorporeal shock wave therapy. Currently, the Modified Ashworth Scale and Modified Tardieu Scale are widely used tools to clinically evaluate spasticity, but the best tool for PSS assessment remained controversial. Ultrasound elastography (UE), including shear wave and strain image as the emerging method to evaluate soft tissue elasticity, became popular in clinical applications. Spastic biceps and gastrocnemius muscles were reported to be significantly stiffer compared to nonparetic muscles or healthy control using shear wave or strain elastography. More studies investigated the utility, reliability, and validity of UE in patients with PSS, but the contemporary consensus for the utility of UE in the measurement and therapeutic follow-up of PSS remained lacking. Therefore, this narrative review aimed to appraise the literature on the shear wave and strain elastography on PSS and summarize the roles of UE in assessing the therapeutic efficacy of different PSS interventions.
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Affiliation(s)
- Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Mei Yang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hao-Wei Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yen-Hua Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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Jia F, Zhu XR, Kong LY, Fan JC, Zhu ZJ, Lin LZ, Zhang SY, Yuan XZ. Stiffness changes in internal rotation muscles of the shoulder and its influence on hemiplegic shoulder pain. Front Neurol 2023; 14:1195915. [PMID: 37332999 PMCID: PMC10272777 DOI: 10.3389/fneur.2023.1195915] [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: 03/29/2023] [Accepted: 05/10/2023] [Indexed: 06/20/2023] Open
Abstract
Background Hemiplegic shoulder pain (HSP) is a common complication in patients with stroke. The pathogenesis of HSP is complex, and muscle hypertonia, especially the hypertonia of internal rotation muscles of the shoulder, may be one of the important causes of shoulder pain. However, the relationship between muscle stiffness and HSP has not been well studied. The purpose of this study is to explore the correlations between the stiffness of internal rotation muscles and clinical symptoms in patients with HSP. Methods A total of 20 HSP patients and 20 healthy controls were recruited for this study. The stiffness of internal rotation muscles was quantified using shear wave elastography, and Young's modulus (YM) of the pectoralis major (PM), anterior deltoid (AD), teres major ™, and latissimus dorsi (LD) were measured. Muscle hypertonia and pain intensity were evaluated using the Modified Ashworth Scale (MAS) and Visual Analog Scale (VAS), respectively. The mobility of the shoulder was evaluated using the Neer score. The correlations between muscle stiffness and the clinical scales were analyzed. Results YM of internal rotation muscles on the paretic side was higher than that of the control group in the resting and passive stretching positions (P < 0.05). YM of internal rotation muscles on the paretic side during passive stretching was significantly higher than that at rest (P < 0.05). YM of PM, TM, and LD during passive stretching were correlated with MAS (P < 0.05). In addition, the YM of TM during passive stretching was positively correlated with VAS and negatively correlated with the Neer score (P < 0.05). Conclusion Increased stiffness of PM, TM, and LD was observed in patients with HSP. The stiffness of TM was associated with pain intensity of the shoulder and shoulder mobility.
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Affiliation(s)
- Fan Jia
- Faculty of Rehabilitation Medicine, Weifang Medical University, Weifang, Shandong, China
| | - Xin-Rui Zhu
- Faculty of Rehabilitation Medicine, Weifang Medical University, Weifang, Shandong, China
| | - Ling-Yu Kong
- Physical Education and Sports School, Soochow University, Suzhou, Jiangsu, China
| | - Jie-Cheng Fan
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Zong-Jing Zhu
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Li-Zhen Lin
- Department of Rehabilitation Medicine, Weifang People's Hospital, Weifang, Shandong, China
| | - Shu-Yun Zhang
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
| | - Xiang-Zhen Yuan
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
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The Sonoelastography and Functional Outcome of Upper Extremity after Kinesiotaping on the Spastic Forearm in Patients with Subacute Stroke. BIOMED RESEARCH INTERNATIONAL 2023; 2023:1730491. [PMID: 36700238 PMCID: PMC9870695 DOI: 10.1155/2023/1730491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
Objectives This study is aimed at exploring the feasibility of sonoelastography on muscle stiffness of spastic forearm and evaluating the improvement of functional performance in patients with poststroke spasticity (PSS) after receiving kinesiotaping (KT) and rehabilitation. Methods According to the spastic levels (using modified Ashworth scale (MAS)) of the affected upper extremity, 59 patients with stroke were allocated into two groups, group A (MAS 0-1): 31 patients (14 men and 17 women; mean age: 60 years) and group B (MAS 1+-2): 28 patients (22 men and 6 women; mean age: 51 years). The Brunnstrom motor recovery stage at the wrist/distal parts in groups A and B was stage 3/3.5 and stage 2.75/3. We evaluated the Brunnstrom stage, spastic levels by MAS and modified Tardieu scale (MTS), and Fugl-Meyer Assessment for upper extremity (FMA-UE). We also evaluated the muscle spasticity of flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and flexor digitorum superficialis (FDS) muscles using sonoelastography with shear wave velocity (SWV). We applied KT for 20 patients in group B, comparing the changes in sonoelastography and functional outcomes between KT and without KT interventions. Results Both the MAS and MTS scales were moderately correlated with the SWV in forearm muscles on hemiplegic side (r = 0.336-0.554) After KT intervention, the SWV in FCR decreased (p = 0.028). Muscle spasticity was reduced (p < 0.01), and distal part of the Brunnstrom stage and FMA-UE were increased (p = 0.045 and p = 0.001). In patients without KT intervention, only the MTS degree reduced (p = 0.026). Conclusions The SWV of sonoelastography could objectively assess the reduction of muscle stiffness of the affected forearms in patients with PSS after KT intervention. Advances in Knowledge. Sonoelastography could be a quantitative method to follow up for therapeutic effect of the spastic forearm.
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Campanella W, Corazza A, Puce L, Privitera L, Pedrini R, Mori L, Boccuni L, Turtulici G, Trompetto C, Marinelli L. Shear wave elastography combined with electromyography to assess the effect of botulinum toxin on spastic dystonia following stroke: A pilot study. Front Neurol 2022; 13:980746. [PMID: 36299267 PMCID: PMC9589110 DOI: 10.3389/fneur.2022.980746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Shear wave elastography (SWE) is a method for carrying out a quantitative assessment of the mechanical properties of soft tissues in terms of stiffness. In stroke survivors, the paretic muscles may develop hypertonia due to both neural-mediated mechanisms and structural alterations with consequent muscular fibrous-fatty remodeling. Methods Fourteen adult patients with spastic dystonia following stroke were recruited. Muscle hypertonia was assessed using the modified Ashworth scale (MAS). Muscle activation was measured by surface electromyography (sEMG) with the selected muscle in shortened (spastic dystonia) and stretched (dynamic stretch reflex) positions. SWE was performed on a selected paretic muscle and on the contralateral non-paretic one to calculate shear wave velocities (SWV) along and across muscular fibers. The modified Heckmatt scale (MHS) pattern was also determined. All evaluations were performed shortly before BoNT-A injections (T0) and one month later (T1). Results All SWV on paretic muscles were higher than contralateral non-paretic ones (p < 0.01). After BoNT-A injection, a significant reduction in MAS (p = 0.0018), spastic dystonia (p = 0.0043), and longitudinal SWE measurements, both in shortened (p = 0.001) and in stretched muscular conditions (p = 0.0029), was observed. No significant changes in SWV on non-paretic muscles were observed. Higher SWV resulted along the direction of muscular fibers vs. across them (p = 0.001). No changes resulted from the MHS evaluations after BoNT-A. There was a positive correlation between MHS scores and SWV values while the muscle was in the shortened position, but not with spastic dystonia recorded by sEMG. Conclusions This is the first study evaluating the effect of BoNT-A on muscle hypertonia following stroke, assessed by both SWE and sEMG. These findings support SWE as a useful method to disclose intrinsic muscular remodeling, independently of the effect of spastic dystonia, in particular, while muscles were assessed in a neutral position. SWE measurements of muscle stiffness cannot tell apart neural-mediated and intrinsic muscle hypertonia. Interestingly, when sEMG activity is very limited, as in spastic muscles kept in a shortened position, SWE can provide a measurement of stiffness due almost completely to intrinsic muscle changes. Alongside sEMG, SWE could aid clinicians in the assessment of responses to treatments.
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Affiliation(s)
- William Campanella
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Angelo Corazza
- Unità di Radiologia Diagnostica ed Interventistica Istituto Ortopedico Galeazzi di Milano, Milan, Italy
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Laura Privitera
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Riccardo Pedrini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Leonardo Boccuni
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Giovanni Turtulici
- S.C. Radiodiagnostica Ospedale Evangelico Internazionale di Genova, Genova, Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Neurorehabilitation, Genova, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Department of Neuroscience, Division of Clinical Neurophysiology, Genova, Italy
- *Correspondence: Lucio Marinelli
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Wei HQ, Gan M, Li GY, Ma SH, Liu JH. Quantitative Evaluation of Biceps Brachii Muscle by Shear Wave Elastography in Stroke Patients. Ther Clin Risk Manag 2022; 18:879-887. [PMID: 36212049 PMCID: PMC9541677 DOI: 10.2147/tcrm.s361664] [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: 02/09/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The present study aimed to investigate the differences in muscle size and shear wave speed (SWS) values of biceps brachii muscle (BBM) between stroke survivors and healthy controls. Methods This study comprised 61 stroke survivors and 24 healthy subjects, examined at Guangzhou First People's Hospital within one year. Each participant underwent ultrasonic examinations for recording some specific measurement indicators, including muscle thickness, cross-sectional area (CSA), and shear wave speed (SWS) of BBM. The muscular tension of the paretic arm was scored using the modified Ashworth scale (MAS). These above-mentioned indexes were compared between stroke survivors and healthy controls. Also, the correlations among SWS and MAS scores were assessed. Results When the lifting arm angle was set for 45°, the CSA and muscle thickness of BBM were obviously decreased in the paretic arms of stroke subjects compared to the non-paretic arms as well as the arms of healthy controls. Moreover, the paretic arms had obviously higher SWS than the non-paretic arms and the healthy arms at 45° or 90°. When the angles of paretic arms were lifted at 90° and 45°, respectively, a positive correlation was established between MAS and SWS. Conclusion Ultrasonic examination assessing muscle thickness, CSA, and SWS of the BBM could be used as a means of assessment of the paretic arms of stroke survivors.
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Affiliation(s)
- Hong-Qin Wei
- Department of Ultrasound, Guangzhou First People’s Hospital, Guangzhou, Guandong, People’s Republic of China
| | - Man Gan
- Department of Ultrasound, Guangzhou First People’s Hospital, Guangzhou, Guandong, People’s Republic of China
| | - Guo-Yan Li
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, Guangzhou, Guandong, People’s Republic of China
| | - Sui-Hong Ma
- Department of Ultrasound, Guangzhou First People’s Hospital, Guangzhou, Guandong, People’s Republic of China,Correspondence: Sui-Hong Ma; Jian-Hua Liu, Tel +86 13824420620; +86 13622888381, Fax +86 020 81332620, Email ;
| | - Jian-Hua Liu
- Department of Ultrasound, Guangzhou First People’s Hospital, Guangzhou, Guandong, People’s Republic of China
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