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Heiss R, Höger SA, Uder M, Hotfiel T, Hanspach J, Laun FB, Nagel AM, Roemer FW. Early functional and morphological changes of calf muscles in delayed onset muscle soreness (DOMS) assessed with 7T MRI. Ann Anat 2024; 251:152181. [PMID: 37871829 DOI: 10.1016/j.aanat.2023.152181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/24/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND To assess morphological and functional alterations of the skeletal muscle in exercise-induced delayed onset muscle soreness (DOMS) using 7 Tesla (T) magnetic resonance imaging (MRI). METHODS DOMS was induced in 16 volunteers performing an eccentric exercise protocol of the calf muscles of one randomized leg. 7 T MRI including T1w- (0.18×0.18×1mm3), T2w-images (0.2×0.2×2mm3), T2-maps (0.5×0.5×5mm3), and susceptibility weighted imaging (SWI, 0.7×0.7×0.7 mm3) were acquired at baseline, directly (t1) and 60 hours (t2) after the exercise. T2 signal intensity (SI), T2 values [ms], T1 SI and SWI were assessed in the medial (MG) and lateral gastrocnemius muscle (LG) and in the soleus muscle (SM). In addition, the serum creatine kinase (CK) activity, range of motion (ROM) of the ankle, calf circumference, and muscle soreness were assessed at each time point. RESULTS Directly after exercise (t1), T2 SI (p=0.04) and T2 values (p=0.03) increased significantly in the LG. No changes of SI and T2 values for MG and SM were present at t1. At t2, T2 SI and T2 values of LG (p=0.001, p=0.02) and MG (p=0.04, p=0.03) increased significantly compared to baseline. T1 SI did not change in any muscle at any time point. In SWI, no signs of intramuscular signal drop could be detected. Clinical parameters confirmed the induction of DOMS, with a significant increase of CK (p=0.03), muscle soreness (p<0.001), calf circumference (p=0.001), and respective a decrease of ROM (p=0.04). CONCLUSIONS 7 T MRI has the potential to visualize microstructural muscle damage immediately after an exercise that induces DOMS. No changes in susceptibility which could, for example, reflect micro-hemorrhage, could be detected with SWI immediately after exercise or in DOMS. Ultra-high field MRI may potentially be used in sports medicine to monitor intramuscular structural changes, allowing for modification of training intensity or to implement appropriate therapeutic strategies.
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Affiliation(s)
- Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany.
| | - Svenja A Höger
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany; Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, Munich 81675, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Thilo Hotfiel
- Department of Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Krankenhausstr. 12, Erlangen 91054, Germany; Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück GmbH, Klinikum Osnabrück, Am Finkenhügel 1, Osnabrück 49076, Germany
| | - Jannis Hanspach
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Frederik B Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Frank W Roemer
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany; Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA
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Gast LV, Baier LM, Meixner CR, Chaudry O, Engelke K, Uder M, Nagel AM, Heiss R. MRI of Potassium and Sodium Enables Comprehensive Analysis of Ion Perturbations in Skeletal Muscle Tissue After Eccentric Exercise. Invest Radiol 2023; 58:265-272. [PMID: 36374200 PMCID: PMC9997635 DOI: 10.1097/rli.0000000000000931] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aims were to investigate if potassium ( 39 K) magnetic resonance imaging (MRI) can be used to analyze changes in the apparent tissue potassium concentration (aTPC) in calf muscle tissue after eccentric exercise and in delayed-onset muscle soreness, and to compare these to corresponding changes in the apparent tissue sodium concentration (aTSC) measured with sodium ( 23 Na) MRI. MATERIALS AND METHODS Fourteen healthy subjects (7 female, 7 male; 25.0 ± 2.8 years) underwent 39 K and 23 Na MRI at a 7 T MR system, as well as 1 H MRI at a 3 T MR system. Magnetic resonance imaging data and blood samples were collected at baseline (t0), directly after performing eccentric exercise (t1) and 48 hours after exercise (t2). Self-reported muscle soreness was evaluated using a 10-cm visual analog scale for pain (0, no pain; 10, worst pain) at t0, t1, and t2. Quantification of aTPC/aTSC was performed after correcting the measured 39 K/ 23 Na signal intensities for partial volume and relaxation effects using 5 external reference phantoms. Edema volume and 1 H T 2 relaxation times were determined based on the 1 H MRI data. Participants were divided according to their increase in creatine kinase (CK) level into high (CK t2 ≥ 10·CK t0 ) and low CK (CK t2 < 10·CK t0 ) subjects. RESULTS Blood serum CK and edema volume were significantly increased 48 hours after exercise compared with baseline ( P < 0.001). Six participants showed a high increase in blood serum CK level at t2 relative to baseline, whereas 8 participants had only a low to moderate increase in blood serum CK. All participants reported increased muscle soreness both at rest and when climbing stairs at t1 (0.4 ± 0.7; 1.4 ± 1.2) and t2 (1.6 ± 1.4; 4.8 ± 1.9) compared with baseline (0 ± 0; 0 ± 0). Moreover, aTSC was increased at t1 in exercised muscles of all participants (increase by 57% ± 24% in high CK, 73% ± 33% in low CK subjects). Forty-eight hours after training, subjects with high increase in blood serum CK still showed highly increased aTSC (increase by 79% ± 57% compared with t0). In contrast, aTPC at t2 was elevated in exercised muscles of low CK subjects (increase by 19% ± 11% compared with t0), in which aTSC had returned to baseline or below. Overall, aTSC and aTPC showed inverse evolution, with changes in aTSC being approximately twice as high as in aTPC. CONCLUSIONS Our results showed that 39 K MRI is able to detect changes in muscular potassium concentrations caused by eccentric exercise. In combination with 23 Na MRI, this enables a more holistic analysis of tissue ion concentration changes.
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Affiliation(s)
| | | | | | - Oliver Chaudry
- Department of Medicine 3, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg
| | - Klaus Engelke
- Department of Medicine 3, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
| | | | - Armin M. Nagel
- From the Institute of Radiology
- Division of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany
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Höger SA, Gast LV, Marty B, Hotfiel T, Bickelhaupt S, Uder M, Heiss R, Nagel AM. Sodium and quantitative hydrogen parameter changes in muscle tissue after eccentric exercise and in delayed-onset muscle soreness assessed with magnetic resonance imaging. NMR Biomed 2023; 36:e4840. [PMID: 36196511 DOI: 10.1002/nbm.4840] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/11/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The objective of the current study was to assess sodium (23 Na) and quantitative proton (1 H) parameter changes in muscle tissue with magnetic resonance imaging (MRI) after eccentric exercise and in delayed-onset muscle soreness (DOMS). Fourteen participants (mean age: 25 ± 4 years) underwent 23 Na/1 H MRI of the calf muscle on a 3-T MRI system before exercise (t0), directly after eccentric exercise (t1), and 48 h postintervention (t2). In addition to tissue sodium concentration (TSC), intracellular-weighted sodium (ICwS) signal was acquired using a three-dimensional density-adapted radial projection readout with an additional inversion recovery preparation module. Phantoms containing saline solution served as references to quantify sodium concentrations. The 1 H MRI protocol consisted of a T1 -weighted turbo spin echo sequence, a T2 -weighted turbo inversion recovery, as well as water T2 mapping and water T1 mapping. Additionally, blood serum creatine kinase (CK) levels were assessed at baseline and 48 h after exercise. The TSC and ICwS of exercised muscles increased significantly from t0 to t1 and decreased significantly from t1 to t2. In the soleus muscle (SM), ICwS decreased below baseline values at t2. In the tibialis anterior muscle (TA), TSC and ICwS remained at baseline levels at each measurement point. However, high-CK participants (i.e., participants with a more than 10-fold CK increase, n = 3) displayed different behavior, with 2- to 4-fold increases in TSC values in the medial gastrocnemius muscle (MGM) at t2. 1 H water T1 relaxation times increased significantly after 48 h in the MGM and SM. 1 H water T2 relaxation times and muscle volume increased in the MGM at t2. Sodium MRI parameters and water relaxation times peaked at different points. Whereas water relaxation times were highest at t2, sodium MRI parameters had already returned to baseline values (or even below baseline values, for low-CK participants) by this point. The observed changes in ion concentrations and water relaxation time parameters could enable a better understanding of the physiological processes during DOMS and muscle regeneration. In the future, this might help to optimize training and to reduce associated sports injuries.
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Affiliation(s)
- Svenja A Höger
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lena V Gast
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Benjamin Marty
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
- NMR Laboratory, CEA/DRF/IBFJ/MIRCen, Paris, France
| | - Thilo Hotfiel
- Department of Orthopedic Surgery, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
| | - Sebastian Bickelhaupt
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Xia Y, Li J, Wang D, Chen J, Shen M, Li F, Wang Y, Jiang P. Potential Application of Low-Intensity Focused Ultrasound in Rapidly Relieving Delayed-Onset Muscle Soreness Induced by High-Intensity Exercise. J Ultrasound Med 2022; 41:2227-2235. [PMID: 34862643 DOI: 10.1002/jum.15904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To evaluate the efficacy of low-intensity focused ultrasound (LIFU) treatment on rapid relief of delayed-onset muscle soreness (DOMS) triggered by high-intensity exercise. METHODS A total of 16 healthy male college students were randomly divided into two groups: the LIFU group (n = 8) and the Sham group (n = 8). After the exercise protocol, the LIFU group received treatment, which parameters included that the power output was 2.5 W/cm2 , the frequency was 1 MHz, and the treating time was 20 minutes. The Sham group was treated with LIFU without energy output. Visual analog scale was used to evaluate the level of DOMS in every participant. The activities of plasma creatine kinase, lactate dehydrogenase, and the plasma concentration were measured by spectrophotometry. Tumor necrosis factor-α and interleukin-6 of serum were analyzed by enzyme-linked immunosorbent assay. RESULTS The visual analog scale of quadriceps femoris and/or calf muscles in the LIFU group decreased significantly at 24 hours (P < 0.01) and 48 hours (P < .01) after the exercise protocol. Both the accumulation of lactic acid (P < .01) in muscle and the activity of lactate dehydrogenase (P < .01) reduced immediately after LIFU treatment. The activities of tumor necrosis factor-α and interleukin-6 24 hours lowered in the LIFU group (P < .01). CONCLUSIONS LIFU treatment could relieve muscle soreness rapidly and effectively in the early stages of DOMS. The application of LIFU may provide a potential strategy for clinical treatment for DOMS.
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Affiliation(s)
- Yi Xia
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jianhu Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Disen Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jinyun Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Mingxue Shen
- College of Exercise Medicine, Chongqing Medical University, Chongqing, China
| | - Faqi Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Yan Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Ping Jiang
- College of Exercise Medicine, Chongqing Medical University, Chongqing, China
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Riexinger A, Laun FB, Höger SA, Wiesmueller M, Uder M, Hensel B, Forst R, Hotfiel T, Heiss R. Effect of compression garments on muscle perfusion in delayed-onset muscle soreness: A quantitative analysis using intravoxel incoherent motion MR perfusion imaging. NMR Biomed 2021; 34:e4487. [PMID: 33594766 DOI: 10.1002/nbm.4487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
The aim of this prospective cohort study was to evaluate the effect of compression garments under resting conditions and after the induction of delayed-onset muscle soreness (DOMS) by MR perfusion imaging using intravoxel incoherent motion (IVIM). Magnetic resonance imaging of both lower legs of 16 volunteers was performed before and after standardized eccentric exercises that induced DOMS. A compression garment (21-22 mmHg) was worn during and for 6 h after exercise on one randomly selected leg. IVIM MR imaging, represented as total muscle perfusion D*f, perfusion fraction f and tissue diffusivity D, were compared between baseline and directly, 30 min, 6 h and 48 h after exhausting exercise with and without compression. Creatine kinase levels and T2-weighted images were acquired at baseline and after 48 h. DOMS was induced in the medial head of the gastrocnemius muscle (MGM) in all volunteers. Compression garments did not show any significant effect on IVIM perfusion parameters at any time point in the MGM or the tibialis anterior muscle (p > 0.05). Microvascular perfusion in the MGM increased significantly in both the compressed and noncompressed leg between baseline measurements and those taken directly after and 30 min after the exercise: the relative median f increased by 31.5% and 24.7% in the compressed and noncompressed leg, respectively, directly after the exercise compared with the baseline value. No significant change in tissue perfusion occurred 48 h after the induction of DOMS compared with baseline. It was concluded that compression garments (21-22 mmHg) do not alter microvascular muscle perfusion at rest, nor do they have any significant effect during the regeneration phase of DOMS. In DOMS, only a short-term effect of increased muscle perfusion (30 min after exercise) was observed, with normalization occurring during regeneration after 6-48 h. The normalization of perfusion independently of compression after 6 h may have implications for diagnostic and therapeutic strategies and for the better understanding of pathophysiological pathways in DOMS.
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Affiliation(s)
- Andreas Riexinger
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | | | | | - Marco Wiesmueller
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Bernhard Hensel
- Center for Medical Physics and Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raimund Forst
- Department of Orthopedic Surgery, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany
| | - Thilo Hotfiel
- Department of Orthopedic Surgery, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
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Hu S, Belcaro G, Cesarone MR, Feragalli B, Cotellese R, Dugall M, Scipione C, Scipione V, Maione C, Maramaldi G, Togni S, Riva A. A sport cream (Harpago-Boswellia-ginger-escin) for localized neck/shoulder pain. Minerva Med 2021; 112:255-260. [PMID: 32880419 DOI: 10.23736/s0026-4806.20.06819-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neck/shoulder, sudden pain, or muscular pain (not associated to structural or bone/joints components), due to fascial or muscular strain is common in active subjects, in non-professional athletes and sports performers. The aim of this supplement registry was the evaluation of a cream based on natural, active ingredients for topical application in supporting the improvement of pain and improving head/neck mobility, possibly minimizing the use of systemic drugs. METHODS The cream includes standardized active ingredients of natural origin as an extract of Harpagophytum procumbes, an extract from Boswellia serrata, a CO2 extract of ginger and escin. Subjects were divided into three groups, all using the standard management (SM) in combination with the Sport Cream or in addition to Flector (diclofenac) patch. RESULTS The groups were comparable and homogeneous at the baseline. No side effects or skin tolerability issues were observed with the Sport Cream nor with the SM or diclofenac patches. Subjects receiving sport cream + SM reported a significant improvement in pain, stiffness, altered mobility and altered working capacity, with a reduced need for rescue medication (diclofenac) compared to subjects in the other two groups. CONCLUSIONS Finally, subjects receiving sport cream + SM reported a more remarkable decrease in skin temperature in the affected area associated to an improvement in clinical symptoms.
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Affiliation(s)
- Shu Hu
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Gianni Belcaro
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy -
- Indena, Milan, Italy
| | - Maria R Cesarone
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Beatrice Feragalli
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Roberto Cotellese
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Mark Dugall
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Claudia Scipione
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Valeria Scipione
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Claudia Maione
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Giada Maramaldi
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Stefano Togni
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
| | - Antonella Riva
- Irvine3 Labs, Department of Medical, Oral and Biotechnological Sciences, Chieti-Pescara University, IAPSS, Pescara, Italy
- Indena, Milan, Italy
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Sanabria SJ, Ruby L, Kuonen J, Dettwiler S, Colombo V, Frauenfelder T, Ettlin D, Rominger MB. Ultrasound Imaging of Injections in Masseter Muscle without Contrast Agent Using Strain Elastography and a Novel B-Mode Spatiotemporal Filter. Ultrasound Med Biol 2020; 46:2717-2735. [PMID: 32753287 DOI: 10.1016/j.ultrasmedbio.2020.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/28/2020] [Accepted: 06/27/2020] [Indexed: 06/11/2023]
Abstract
Botulinum toxin type A (BTX-A) injections in masseter muscle can alleviate muscle tightness and aching pain caused by idiopathic masticatory myalgia, a subform of the myofascial pain syndrome. Yet the injection procedure (number, amount) is currently empirical. In this ex vivo study, we determined the feasibility of using contrast-free ultrasound imaging to visualize the short-term injectate propagation. Ultrasound annotations of BTX-A injectate spread in N = 12 porcine masseter muscles were compared with the histopathology of the excised masseter. BTX-A presence was automatically detected in the ultrasound cine by: compensating tissue motion and deformation during injection with a novel spatiotemporal filtering (SF) algorithm, and by imaging tissue swelling strains with strain elastography (SE). BTX-A injectate introduced 6.5% (standard deviation = 5.0%) echogenicity contrast and 13.9% (standard deviation = 3.7%) tissue swelling strain. Muscle fasciae were a border for BTX-A distribution. The SF algorithm achieved significantly higher noise rejection (contrast-to-noise ratio = 4.63) than SE (2.56, p = 0.01), and state-of-the-art 2-D digital image correlation (1.81, p < 0.001) and direct image subtraction (1.29, p < 0.001) methods. Histopathology agreed well with ultrasound (Dice coefficient = 0.48), with deviations mainly explained by the three-dimensional inhomogeneous distribution of BTX-A. Preliminary in vivo patient results indicated that SF and SE discard artifactual BTX-A detection outside the injection region. The proposed methods contribute to objectivize ultrasound-guided injections, with additional applications, for instance, to monitor injectate spread of local anesthetics.
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Affiliation(s)
- Sergio J Sanabria
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
| | - Lisa Ruby
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Jasmine Kuonen
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Susanne Dettwiler
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Vera Colombo
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Dominik Ettlin
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Marga B Rominger
- Zurich Ultrasound Research and Translation (ZURT), Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Di Paolo C, Papi P, Falisi G, Pompa G, Santilli V, Polimeni A, Fiorini A. Subjects with temporomandibular joint disc displacement and body posture assessment via rasterstereography: a pilot case-control study. Eur Rev Med Pharmacol Sci 2020; 24:8703-8712. [PMID: 32964958 DOI: 10.26355/eurrev_202009_22807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The possible relationship between temporomandibular disorders (TMDs) and body posture is still controversial. Rasterstereography has been introduced as a radiation-free, reliable and non-invasive method to analyze three-dimensional spinal posture. The aim of this case-control study is to evaluate, through rasterstereography, body posture parameters in a group of patients with reducible unilateral dislocation of the articular disc, compared to healthy volunteers. PATIENTS AND METHODS Rasterstereographic recordings obtained were compared between the two groups with a paired t-student test. Furthermore, the relationship between Rasterstereographic recordings and clinical data in the TMD group were analyzed by means of multiple regression analysis. RESULTS Only lateral deviation was statistically significant different between the two groups (rms VPDM Control group 40% > TMD group, p=0.02; 43% control group VPDM max > TMD group, p<0.02). In the TMD group, a significant relationship (p<0.05) was found out between lateral and rotational deviations of the column and muscular pain, therefore suggesting a possible overactivity of the masticatory muscles, especially of lateral pterygoids' bilaterally and the left masseter. CONCLUSIONS Patients with reducible unilateral disc displacement showed limited postural alterations compared to healthy volunteers, only lateral deviations (VPDM rms and VPDM-max) were statistically significant (Œ <0.05) between the two groups.
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Affiliation(s)
- C Di Paolo
- Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Rome, Italy.
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Dhital R, Basnet S, Poudel DR. Acute Proximal Myopathy in a Young Male—A Case of Infectious Myositis. Medicina (B Aires) 2019; 55:medicina55010019. [PMID: 30658484 PMCID: PMC6359648 DOI: 10.3390/medicina55010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
Background and objectives: Acute proximal muscle weakness has a broad differential. Infectious myositis is difficult to differentiate clinically from inflammatory myopathy, often causing a delayed diagnosis. Infectious myositis should be thought of as a differential for proximal muscle pain and weakness in the right context. Case Presentation: A 40-year-old male with diabetes presented with exquisite pain and weakness of proximal extremities. He denied trauma, recent travel, new medications, or substance use. He denied prior rheumatologic, thyroid, or musculoskeletal disorders. The urine culture revealed staphylococcal infection with negative blood cultures. Rheumatologic and endocrine workups were negative. Random muscle biopsy was negative for inflammatory infiltrate. MRI of thighs and arms showed innumerable foci of nodular and ring enhancement in the proximal muscle groups. The patient noted improvement after about 10 days of antibiotics with complete resolution at 2 months. Discussion and Conclusion: Bacterial myositis is most often due to Staphylococcus aureus (70%) and affects a single muscle. Multifocal abscesses are rare and strongly suggest transient bacteremia. Our patient most likely had transient initiating staphylococcal bacteremia leading to diffuse myositis and hematogenous urinary tract infection (UTI). A delay in treatment can be life-threatening.
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Affiliation(s)
- Rashmi Dhital
- Reading Hospital, Tower Health System, West Reading, PA 19611, USA.
| | - Sijan Basnet
- Reading Hospital, Tower Health System, West Reading, PA 19611, USA.
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Abstract
The initial symptoms of Crohn's disease (CD) sometimes present as extraintestinal lesions, which can be a diagnostic challenge for physicians. Painful legs, known as "gastrocnemius myalgia syndrome", are rare complications that often precede abdominal manifestations. We herein report the case of a 38-year-old man who presented with bilateral leg myalgia lasting for 4 months. Magnetic resonance imaging showed abnormal intensity, and a muscle biopsy revealed inflammatory cell infiltration. Abdominal symptoms appeared three months after the myalgia onset, and the diagnosis of CD was confirmed later by endoscopic and radiological findings. To our knowledge, this is the first description of gastrocnemius myalgia syndrome in Japan.
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Affiliation(s)
- Atsumu Osada
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Japan
| | - Hiroaki Yamada
- Department of Gastroenterology, Kosinkai Shiomidai Hospital, Japan
| | - Sayuri Takehara
- Department of Gastroenterology, Yokohama Minami Kyosai Hospital, Japan
| | | | - Taito Fukushima
- Department of Gastroenterology, Kanagawa Cancer Center, Japan
| | - Hiroyuki Oka
- Department of Gastroenterology, Yokohama Minami Kyosai Hospital, Japan
| | - Hiroshi Okazaki
- Department of Gastroenterology, Yokohama Minami Kyosai Hospital, Japan
| | - Shohei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Japan
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Tamborrini G, Leumann A. [Not Available]. Praxis (Bern 1994) 2018; 107:403-404. [PMID: 29587590 DOI: 10.1024/1661-8157/a002925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Giorgio Tamborrini
- 1 Institut für Ultraschall des Bewegungsapparates und Rheumatologie, Basel
| | - André Leumann
- 2 OrthoPraxis Leumann, Orthopädische Chirurgie und Traumatologie des Bewegungsapparates und Sportmedizin, Basel
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Longo V, Jacobson JA, Fessell DP, Mautner K. Ultrasound Findings of Delayed-Onset Muscle Soreness. J Ultrasound Med 2016; 35:2517-2521. [PMID: 27738295 DOI: 10.7863/ultra.15.12066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/06/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this series was to retrospectively characterize the ultrasound findings of delayed-onset muscle soreness (DOMS). The Institutional Review Board approved our study, and informed consent was waived. A retrospective search of radiology reports using the key phrase "delayed-onset muscle soreness" and key word "DOMS" from 2001 to 2015 and teaching files was completed to identify cases. The sonograms were reviewed by 3 fellowship-trained musculoskeletal radiologists by consensus. Sonograms were retrospectively characterized with respect to echogenicity (hypoechoic, isoechoic, or hyperechoic), distribution of muscle involvement, and intramuscular pattern (focal versus diffuse and well defined versus poorly defined). Images were also reviewed for muscle enlargement, fluid collection, muscle fiber disruption, and increased flow on color or power Doppler imaging. There were a total of 6 patients identified (5 male and 1 female). The average age was 22 years (range, 7-44 years). Of the 6 patients, there were a total of 11 affected muscles in 7 extremities (1 bilateral case). The involved muscles were in the upper extremity: triceps brachii in 27% (3 of 11), biceps brachii in 18% (2 of 11), brachialis in 18% (2 of 11), brachioradialis in 18% (2 of 11), infraspinatus in 9% (1 of 11), and deltoid in 9% (1 of 11). On ultrasound imaging, the abnormal muscle was hyperechoic in 100% (11 of 11), well defined in 73% (8 of 11), poorly defined in 27% (3 of 11), diffuse in 73% (8 of 11), and focal in 27% (3 of 11). Increased muscle size was found in 82% (9 of 11) and minimal hyperemia in 87.5% (7 of 8). The ultrasound findings of DOMS include hyperechoic involvement of an upper extremity muscle, most commonly appearing well defined and diffuse with increased muscle size and minimal hyperemia.
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Affiliation(s)
- Victor Longo
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - David P Fessell
- Department of Radiology, University of Michigan, Ann Arbor, Michigan USA
| | - Kenneth Mautner
- Department of Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia USA
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Hicks KM, Onambélé GL, Winwood K, Morse CI. Muscle Damage following Maximal Eccentric Knee Extensions in Males and Females. PLoS One 2016; 11:e0150848. [PMID: 26986066 PMCID: PMC4795791 DOI: 10.1371/journal.pone.0150848] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/19/2016] [Indexed: 11/19/2022] Open
Abstract
Aim To investigate whether there is a sex difference in exercise induced muscle damage. Materials and Method Vastus Lateralis and patella tendon properties were measured in males and females using ultrasonography. During maximal voluntary eccentric knee extensions (12 reps x 6 sets), Vastus Lateralis fascicle lengthening and maximal voluntary eccentric knee extensions torque were recorded every 10° of knee joint angle (20–90°). Isometric torque, Creatine Kinase and muscle soreness were measured pre, post, 48, 96 and 168 hours post damage as markers of exercise induced muscle damage. Results Patella tendon stiffness and Vastus Lateralis fascicle lengthening were significantly higher in males compared to females (p<0.05). There was no sex difference in isometric torque loss and muscle soreness post exercise induced muscle damage (p>0.05). Creatine Kinase levels post exercise induced muscle damage were higher in males compared to females (p<0.05), and remained higher when maximal voluntary eccentric knee extension torque, relative to estimated quadriceps anatomical cross sectional area, was taken as a covariate (p<0.05). Conclusion Based on isometric torque loss, there is no sex difference in exercise induced muscle damage. The higher Creatine Kinase in males could not be explained by differences in maximal voluntary eccentric knee extension torque, Vastus Lateralis fascicle lengthening and patella tendon stiffness. Further research is required to understand the significant sex differences in Creatine Kinase levels following exercise induced muscle damage.
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Affiliation(s)
- K. M. Hicks
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-Upon-Tyne, United Kingdom
- Institute for Performance Research, Department of Exercise and Sport Science, Manchester Metropolitan University Cheshire, Manchester, United Kingdom
- * E-mail:
| | - G. L. Onambélé
- Institute for Performance Research, Department of Exercise and Sport Science, Manchester Metropolitan University Cheshire, Manchester, United Kingdom
| | - K. Winwood
- Institute for Performance Research, Department of Exercise and Sport Science, Manchester Metropolitan University Cheshire, Manchester, United Kingdom
| | - C. I. Morse
- Institute for Performance Research, Department of Exercise and Sport Science, Manchester Metropolitan University Cheshire, Manchester, United Kingdom
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Tucker K, Hodges PW, Van den Hoorn W, Nordez A, Hug F. Does stress within a muscle change in response to an acute noxious stimulus? PLoS One 2014; 9:e91899. [PMID: 24626150 PMCID: PMC3953640 DOI: 10.1371/journal.pone.0091899] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/11/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Altered muscle activation during pain is thought to redistribute stress within muscles and ultimately decrease the load on painful structures. However, change in muscle stress during pain has not been directly tested. The aim of the present study is to determine whether stress within muscle tissue is reduced during local acute experimental pain. METHODS AND RESULTS Ten participants attended 2 experimental sessions that each involved isometric knee extension tasks in 2 series of control trials and 1 series of test trials at ∼10%MVC. Shear elastic modulus was measured from vastus lateralis using a shear wave elastographic technique (Supersonic Shear Imaging). Prior to the test contractions, a bolus of hypertonic (Pain) or isotonic saline (No-pain) was injected into vastus lateralis. Pain intensity was 5.2±1.0 during the painful contractions. The intra-session repeatability of the shear elastic modulus determined between control trials was good (ICC: 0.95 and 0.99; SEM: 5.1 and 9.3 kPa for No-pain and Pain, respectively). Muscle shear elastic modulus did not change systematically during Pain or No-pain contractions (all main effects and interaction P>0.14). Examination of data for individual participants showed that stress either increased or decreased. If the absolute change in modulus is considered between the control and the test trials, the change during Pain (16.2±9.5 kPa) was double that observed with No pain (7.9±5.9 kPa; P = 0.046). CONCLUSION This is the first study to directly determine the change in stress within a muscle (change in shear elastic modulus) during pain. We conclude that experimental pain induced by hypertonic saline does not induce a systematic reduction in muscle stress during a single-joint isometric task. Therefore, the changes in muscle activity reported previously during similar tasks are unlikely to systematically reduce load in the painful region. Whether the individual-specific increase and decrease are physiologically relevant or purposeful requires further investigation.
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Affiliation(s)
- Kylie Tucker
- School of Health and Rehabilitation Sciences, National Health and Medical Research Council (NHMRC) Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul W. Hodges
- School of Health and Rehabilitation Sciences, National Health and Medical Research Council (NHMRC) Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Wolbert Van den Hoorn
- School of Health and Rehabilitation Sciences, National Health and Medical Research Council (NHMRC) Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Antoine Nordez
- University of Nantes, Laboratory “Motricité, Interactions, Performance” (EA 4334), Nantes, France
| | - François Hug
- School of Health and Rehabilitation Sciences, National Health and Medical Research Council (NHMRC) Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, Brisbane, Queensland, Australia
- University of Nantes, Laboratory “Motricité, Interactions, Performance” (EA 4334), Nantes, France
- * E-mail:
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Bhadada SK, Sridhar S, Steenackers E, Dhiman V, Mortier G, Bhansali A, Van Hul W. Camurati-Engelmann disease (progressive diaphyseal dysplasia): reports of an Indian kindred. Calcif Tissue Int 2014; 94:240-7. [PMID: 24154985 DOI: 10.1007/s00223-013-9804-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
Camurati-Engelmann disease (CED, OMIM 131300), or progressive diaphyseal dysplasia, is a rare autosomal dominant skeletal dysplasia, caused by mutations in the transforming growth factor-β1 (TGFβ1) gene. We describe the first Indian CED family with genetic confirmation and presenting manifestations. The proband is a 17-year-old woman who presented with lower limb pain and proximal muscle weakness. Skeletal radiographs of the long bones revealed cortical, periosteal, and endosteal thickenings, predominantly affecting the diaphyses of the long bones. On detailed evaluation, there was a strong family history of bone disorder with similar symptoms of pain and radiological findings in several family members. Exon sequencing of the TGFβ1 gene was performed in available family members. Based on clinical and radiographic studies and its familial nature, a diagnosis of CED was made and confirmed by mutation analysis. A heterozygous G to A transition in exon 4 of the TGFβ1 gene (R218H) was detected in 5 out of 10 available family members, including 4 affecteds and 1 asymptomatic individual. Many of our affected individuals responded to glucocorticoids and cortical windowing. CED is a rare genetic disease with variable clinical manifestations and incomplete penetrance. CED needs to be considered in the differential diagnosis of nonspecific limb pain and waddling gait in all young individuals.
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Affiliation(s)
- Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,
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