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Kim SG, Park B, Hwang K, Jeong WK. Reliability of Ultrasound Elastography According to Experience Level and Anatomic Location. Clin Orthop Surg 2025; 17:166-173. [PMID: 39912077 PMCID: PMC11791484 DOI: 10.4055/cios24190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 02/07/2025] Open
Abstract
Backgroud Strain elastography (SE) and shear wave elastography (SWE) are emerging techniques for evaluating the elasticity of soft tissue. This study aimed to determine interobserver and intraobserver reliability for elasticity measurements of different tissues and anatomic locations using SE and SWE. Methods Ten healthy adult male individuals with 20 upper extremities participated in this study. The elasticities of the wrist extensor muscle, the common extensor tendon, and supraspinatus tendon were measured. Strain ratio and shear wave velocity were measured twice by 2 different examiners (examiner 1 with over 20 years of experience in musculoskeletal sonography and examiner 2 with 1 year of experience). Interobserver and intraobserver reliability was assessed using the intraclass correlation coefficient (ICC). Results The 10 individuals' age ranged from 28 to 35 years. In SE, interobserver reliabilities at the 3 anatomic locations (wrist extensor muscle, common extensor tendon, and supraspinatus tendon) showed fair to moderate agreement (ICC = 0.489, p = 0.076; ICC = 0.408, p = 0.131; and ICC = 0.296, p = 0.711, respectively). The intraobserver reliabilities of examiner 1 were moderate to substantial only at the wrist extensor muscle and the common extensor tendon (ICC = 0.563, p = 0.039 and ICC = 0.702, p = 0.006, respectively). In SWE, interobserver reliabilities for the wrist extensor muscle and the supraspinatus tendon were moderate to substantial (ICC = 0.756, p = 0.002 and ICC = 0.565, p = 0.039, respectively). The intraobserver reliabilities of examiner 1 at the 3 anatomic locations were almost perfect (ICC = 0.843, p = 0.001; ICC = 0.800, p = 0.001; and ICC = 0.825, p = 0.001, respectively). The results of examiner 2 showed almost perfect agreement at the wrist extensor muscle (ICC = 0.886, p = 0.001) and moderate to substantial agreement at the tendons of the common extensor and supraspinatus (ICC = 0.592, p = 0.029 and ICC = 0.682, p = 0.008, respectively). Conclusions SWE is a reliable method for assessing the flexibility of soft tissue, but it is affected by expertise and the specific anatomical site.
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Affiliation(s)
- Seul-Gi Kim
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Bongkyung Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyosun Hwang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woong Kyo Jeong
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Adler RS. What is the place of ultrasound in MSK imaging? Skeletal Radiol 2024; 53:1699-1709. [PMID: 38492028 DOI: 10.1007/s00256-024-04642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
During the past four decades, ultrasound has become popular as an imaging modality applied to the musculoskeletal (MSK) system, particularly outside the USA, due to its low cost, accessibility, and lack of ionizing radiation. A basic requirement in performing these examinations is to have a core group of radiologists and ultrasound technologists with expertise in MSK ultrasound. The extent to which ultrasound will be part of the imaging offered by a particular radiology practice or in an academic institution will vary according to expertise, availability, and reimbursements. A brief discussion of the technical capabilities of the current generation of ultrasound scanners will be followed by a description of some of the more prevalent MSK ultrasound imaging applications. The extent to which training to perform these exams within and outside of Radiology plays a role is discussed. Applications that are unique to ultrasound, such as dynamic evaluation of musculoskeletal anatomy and some, US-guided interventions are an important part of MSK imaging. Ultrasound is increasingly important in the assessment of superficial structures, such as tendons, small joints, and peripheral nerves. These applications help to establish the place of ultrasound as an important part of the Radiologists approach to MSK imaging. Outside of radiology, for a variety of clinical subspecialties, ultrasound already plays an integral role in MSK imaging.
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Affiliation(s)
- Ronald S Adler
- Department of Radiology NYU Grossman School of Medicine, 333 East 38Th Street, 6-209, New York, NY, USA.
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3
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Santos R, Loft MK, Pedersen MRV. Elastography of the Male Pelvic Region-Perspectives on Malignant Lesions. Diagnostics (Basel) 2024; 14:1218. [PMID: 38928634 PMCID: PMC11202996 DOI: 10.3390/diagnostics14121218] [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: 04/28/2024] [Revised: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024] Open
Abstract
Ultrasound elastography is widely used to assess tissue stiffness for lesion characterization, including differentiation between benign and malignant lesions. This study focuses on the use of elastography in the male pelvis, including the prostate, testicles, and rectum, by comparing elastography types (shear wave and strain). This article provides a summary of the existing literature on the use of elastography in the male pelvic region and outlines the clinical perspective. Ultrasound elastography is a good technique for evaluating and monitoring lesions in the male pelvic region.
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Affiliation(s)
- Rute Santos
- Medical Imaging and Radiotherapy Department, Coimbra Health School, Polytechnic University of Coimbra, 3045-093 Coimbra, Portugal
- H&TRC—Health & Technology Research Center, Coimbra Health School, Polytechnic University of Coimbra, 3045-093 Coimbra, Portugal
- CIPER-UC, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Martina Kastrup Loft
- Department of Radiology, University Hospital of Southern Denmark, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark; (M.K.L.); (M.R.V.P.)
- Department of Radiology, University Hospital of Southern Denmark, Kolding Hospital, Sygehusvej 24, 6000 Kolding, Denmark
| | - Malene Roland Vils Pedersen
- Department of Radiology, University Hospital of Southern Denmark, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark; (M.K.L.); (M.R.V.P.)
- Department of Radiology, University Hospital of Southern Denmark, Kolding Hospital, Sygehusvej 24, 6000 Kolding, Denmark
- Department of Regional Health, Faculty of Health, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark
- Discipline of Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, T12 AK54 Cork, Ireland
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Billy J, Bensamoun SF, Mercier J, Durand S. Applications of ultrasound elastography to hand and upper limb disorders. HAND SURGERY & REHABILITATION 2024; 43:101636. [PMID: 38215880 DOI: 10.1016/j.hansur.2024.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024]
Abstract
Ultrasound elastography is a recently developed method for accurate measurement of soft tissue stiffness in addition to the clinician's subjective evaluation. The present review briefly describes the ultrasound elastography techniques and outlines clinical applications for tendon, muscle, nerve, skin and other soft tissues of the hand and upper limb. Strain elastography provides a qualitative evaluation of the stiffness, and shear-wave elastography generates quantitative elastograms superimposed on a B-mode image. The stiffness in degenerative tendinopathy and/or tendon injury was significantly lower than in a normal tendon in several studies. Elastography is also a reliable method to evaluate functional muscle activity, compared to conventional surface electromyography. The median nerve is consistently stiffer in patients with carpal tunnel syndrome than in healthy subjects, on whatever ultrasound elastography technique. Elastography distinguishes normal skin from scars and can be used to evaluate scar severity and treatment. Elastography has huge clinical applications in musculoskeletal tissues. Continued development of systems and increased training of clinicians will expand our knowledge of elastography and its clinical applications in the future.
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Affiliation(s)
- Jessica Billy
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sabine F Bensamoun
- Sorbonne University, Université de Technologie de Compiègne, CNRS UMR 7338, Biomechanics and Bioengineering, Compiègne, France
| | - Julie Mercier
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sébastien Durand
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland.
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Grinbaum E, Shulman I, Rozen N, Rubin G. Finger flexor rigidity in the healthy population. Sci Rep 2024; 14:2965. [PMID: 38316861 PMCID: PMC10844215 DOI: 10.1038/s41598-024-52971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
The involvement of the hand flexors in trigger finger is not clear. This study aimed to examine the rigidity of the flexor tendon in the first pulley territory in the hand by using ultrasound in a healthy population, as well as to create a reference scale of rigidity for the flexor tendons to compare those values in trigger fingers. We tested 35 healthy volunteers using a linear ultrasound transducer and the color Doppler method. Rigidity levels below the first pulley were examined and compared between the different fingers of the hand and the relationship between rigidity and sex and the three different age groups was evaluated. In the healthy population, the rigidity of the flexor tendons of the hand in the territory of the first pulley varied between 233.1 and 962.8 kPa, with an average of 486.42 kPa and standard deviation of 114.85. We showed that the flexors in the dominant hand were more rigid, there was a difference between the rigidity of the flexor tendons of the thumb and the other fingers of the same hand, and the ring finger of the dominant hand had stiffer flexor tendons than the fingers of the other hand in the male population. We created a value scale for the rigidity of the flexor tendons of the fingers. This base scale can be compared between different pathologies, including trigger finger. The study and all experimental protocols were approved by the local ethical committee.
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Affiliation(s)
- Erez Grinbaum
- Orthopedic Department, Emek Medical Center, Afula, Israel
| | - Igor Shulman
- Orthopedic Department, Emek Medical Center, Afula, Israel
| | - Nimrod Rozen
- Orthopedic Department, Emek Medical Center, Afula, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Guy Rubin
- Orthopedic Department, Emek Medical Center, Afula, Israel.
- Faculty of Medicine, Technion, Haifa, Israel.
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Ustabaşıoğlu F, Günay B, Samancı C, Emre Ustabaşıoğlu F. Assessment of common extensor tendon vascularization using superb microvascular imaging: a potential tool in the evaluation of extracorporeal shock wave therapy and therapeutic ultrasound effectiveness in lateral epicondylitis. Acta Radiol 2023; 64:2828-2835. [PMID: 37553907 DOI: 10.1177/02841851231191069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Lateral epicondylitis, also known as tennis elbow, is the most common elbow pain in the adult age group. PURPOSE To evaluate common extensor tendon (CET) vascularity with superb microvascular imaging (SMI) before and after extracorporeal shock wave therapy (ESWT) and ultrasound (US) treatment in patients with lateral epycondylitis and to compare the effects of two different treatments on tendon vascularity. MATERIAL AND METHODS Patients with lateral epycondylitis were divided into two groups; 30 patients were treated with ESWT (group 1) and 30 patients were treated with therapeutic US (group 2). We performed a high-frequency (14-MHz) linear array transducer to evaluate tendon anatomy and vascularity before and after treatment in both groups. RESULTS The decrease in Patient-Rated Tennis Elbow Evaluation (PRTEE) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). Likewise, the decrease in visual analog scale (VAS) score after treatment was statistically significant compared to pre-treatment for both groups (P < 0.001). A significant difference was found between the CET SMI values of group 1 and group 2 after treatment, according to the chi-square test (P < 0.001). In the post-treatment VAS and PRTEE comparison of both groups, the score reduction in group 1 was higher than in group 2, and this decrease was statistically significant (P < 0.001). CONCLUSION We can evaluate CET vascularization with the SMI method as a new potential diagnostic tool in comparing the effectiveness of different treatments in cases of lateral epicondylitis.
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Affiliation(s)
- Fatma Ustabaşıoğlu
- Department of Physical Medicine and Rehabilitation, Edirne Sultan 1st Murat State Hospital, Edirne, Turkey
| | - Burak Günay
- Department of Radiology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Cesur Samancı
- Department of Radiology, Istanbul University Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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Adler RS. Musculoskeletal ultrasound: a technical and historical perspective. J Ultrason 2023; 23:e172-e187. [PMID: 38020513 PMCID: PMC10668930 DOI: 10.15557/jou.2023.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/21/2023] [Indexed: 12/01/2023] Open
Abstract
During the past four decades, musculoskeletal ultrasound has become popular as an imaging modality due to its low cost, accessibility, and lack of ionizing radiation. The development of ultrasound technology was possible in large part due to concomitant advances in both solid-state electronics and signal processing. The invention of the transistor and digital computer in the late 1940s was integral in its development. Moore's prediction that the number of microprocessors on a chip would grow exponentially, resulting in progressive miniaturization in chip design and therefore increased computational power, added to these capabilities. The development of musculoskeletal ultrasound has paralleled technical advances in diagnostic ultrasound. The appearance of a large variety of transducer capabilities and rapid image processing along with the ability to assess vascularity and tissue properties has expanded and continues to expand the role of musculoskeletal ultrasound. It should also be noted that these developments have in large part been due to a number of individuals who had the insight to see the potential applications of this developing technology to a host of relevant clinical musculoskeletal problems. Exquisite high-resolution images of both deep and small superficial musculoskeletal anatomy, assessment of vascularity on a capillary level and tissue mechanical properties can be obtained. Ultrasound has also been recognized as the method of choice to perform a large variety of interventional procedures. A brief review of these technical developments, the timeline over which these improvements occurred, and the impact on musculoskeletal ultrasound is presented below.
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Affiliation(s)
- Ronald Steven Adler
- Department of Radiology, New York University, Grossman School of Medicine, Langone Orthopedic Center, New York, USA
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Lerchbaumer MH, Diekhoff T. [MRI or ultrasound-which imaging technique do we need?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:349-358. [PMID: 37039910 DOI: 10.1007/s00132-023-04368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/12/2023]
Abstract
Diagnostic imaging of epicondylitis is primarily performed using widely available, radiation-free ultrasound. The dynamic examination allows a rapid point-of-care assessment. Typical imaging findings of epicondylitis include intratendinous hypoechogenic foci at the humeral origin, ossification at the enthesis, intratendinous calcifications, or (partial) rupture. In particular, Doppler sonography increases sensitivity by assessing possible neovascularization within the tendon. When sonographic findings are unclear or extensive, or when ultrasound machines or the required expertise in elbow examinations are not available, magnetic resonance imaging is indicated. Here, the use of proton density-weighted sequences is appropriate for assessing bone marrow and soft tissue edema and tendon tears, while ossifications are best delineated in T1weighted sequences. Projection radiography and computed tomography can be helpful for larger ossifications, although they are not part of the standard imaging protocol.
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Affiliation(s)
- Markus H Lerchbaumer
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland
- Interdisziplinäres Ultraschallzentrum und US-Forschungslabor, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland
| | - Torsten Diekhoff
- Klinik für Radiologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland.
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Hong S, Hahn S, Yi J, Park EJ, Bang JY. Comparing the clinical application of strain elastography and shear wave elastography for the evaluation of lateral epicondylitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:123-130. [PMID: 36169174 DOI: 10.1002/jcu.23356] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE This study aimed to compare the diagnostic performance of gray-scale ultrasound (GSU), strain elastography (SE), and shear wave elastography (SWE) for lateral epicondylitis (LE). METHODS From November 2018 to March 2021, 87 common extensor tendons (CETs) of 70 patients were evaluated using elbow ultrasound. Patients were divided into two groups: patients with LE and those without lateral elbow pain. GSU, SE, and SWE findings from the two groups were compared, and the diagnostic performance was compared for significant variables. RESULTS Among the 70 patients, 41 with 44 CETs were clinically diagnosed with LE, and 29 with 43 CETs had no lateral elbow pain. Hypoechogenicity, calcification, and hyperemia were significantly different. Strain ratio (SR), stiffness, and shear wave velocity (SWV) were also significantly different. The diagnostic accuracy of stiffness and SWV was better than that of other significant findings. Furthermore, there were no superiorities in SR, stiffness, or SWV. CONCLUSION Both SE and SWE can be valuable diagnostic tools for diagnosing LE. The diagnostic performances of both SE and SWE were similar in the detection of LE.
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Affiliation(s)
- Sujin Hong
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Eun Joo Park
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
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Altaş EU, Birlik B, Şahin Onat Ş, Özoğul Öz B. The comparison of the effectiveness of Kinesio Taping and dry needling in the treatment of lateral epicondylitis: a clinical and ultrasonographic study. J Shoulder Elbow Surg 2022; 31:1553-1562. [PMID: 35483568 DOI: 10.1016/j.jse.2022.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to investigate the short- and long-term effects of Kinesio Taping (KT) and dry needling (DN) applications on pain, functionality, and muscle strength in patients with lateral epicondylitis by use of questionnaires and ultrasonography. METHODS Seventy-eight patients were randomized into 3 groups. Each group followed a program that consisted of 9 treatment sessions in total, with 3 sessions per week for 3 weeks. Group 1 received KT and performed exercise, group 2 received DN and performed exercise, and group 3 performed exercise alone. Pain, functional status, grip strength, and the thickness and echogenicity of the common extensor tendon were evaluated before treatment, after treatment (at the end of the third week), and after 6 months. RESULTS In intragroup evaluations, KT and DN were found to be effective in the short and long term in terms of pain, functional status, muscle strength, and tendon thickness (P < .01). In intergroup evaluations, improvement in the KT and DN groups was superior to that in the control group for all parameters (P < .05). On comparison of the KT and DN groups, improvements in the clinical parameters and tendon thickness, heterogeneity, and elastography were significantly better in the DN group in the short and long term (P < .05). CONCLUSIONS The ultrasonographic outcomes in our study objectively demonstrated that although DN in general is superior in the treatment of lateral epicondylitis, KT treatment is also effective.
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Affiliation(s)
- Elif Umay Altaş
- Department of Physical Medicine and Rehabilitation, Bakırçay University Çiğli Training and Research Hospital, Izmir, Turkey.
| | - Bilge Birlik
- Department of Radiology, Katip Çelebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Şule Şahin Onat
- Department of Physical Medicine and Rehabilitation, Republic of Turkey Ministry of Health, University of Health Sciences, Hamidiye School of Medicine, Gaziler Physical Medicine and Rehabilitation Health Application and Research Center, Ankara, Turkey
| | - Bengi Özoğul Öz
- Department of Physical Medicine and Rehabilitation, Katip Çelebi University Atatürk Education and Research Hospital, Izmir, Turkey
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Mao J, Xiang L. Ultrasound Diagnosis Technology for Sports Injury Detection and Prevention: A Mini Review. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ultrasound as a medical diagnosis tool, comprising the strengths of noninvasive, portable and cost-saving, and it allows the evaluation of soft tissue pathology. In sports medicine field, sonography technology is used for the detection and prevention of injuries of upper and lower limbs,
mainly including elbow, shoulder, knee and ankle joints. The implement of ultrasound diagnosis technology was discussed in this narrative literature review. Sonographic images of elbows could provide a dynamic assessment of medial joint laxity. Due to the importance of ultrasound assessment
in lower-limb muscles, tendons, and ligaments, this technology has been applied extensively for many types of extra-articular injuries in the lower limb. Most muscle injuries can be assessed and graded using the ultrasound apparatus. Overall, sonographic image evaluation is a reliable and
handy method for the initial examination of acute or chronic sports injuries.
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Affiliation(s)
- Jiansheng Mao
- Department of Physical Education, Zhejiang Wanli University, Zhejiang, 315100, China
| | - Liangliang Xiang
- Auckland Bioengineering Institute, University of Auckland, Auckland, 1010, New Zealand
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Balaban M, Cilengir AH, Idilman IS. Evaluation of Tendon Disorders With Ultrasonography and Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1267-1286. [PMID: 33078869 DOI: 10.1002/jum.15520] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
The frequency of musculoskeletal system ultrasonography (US) has increased over time. The most common reason for musculoskeletal US is the evaluation of tendons. The superficial location of tendons makes US the most suitable diagnostic tool, and US is generally the initial imaging modality for tendon disorders. The primary advantages of US are its low cost, easy accessibility, rapidity, repeatability, freedom from x-rays, and enabling of a dynamic inspection. In addition, Doppler US and elastography can be performed simultaneously with US. We aimed to demonstrate the US and elastographic findings of tendon disorders that we frequently encounter in different regions.
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Affiliation(s)
- Mehtap Balaban
- Department of Radiology, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | | | - Ilkay S Idilman
- Department of Radiology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Shear Wave Elastography of the Plantar Fascia: Comparison between Patients with Plantar Fasciitis and Healthy Control Subjects. J Clin Med 2021; 10:jcm10112351. [PMID: 34072045 PMCID: PMC8199455 DOI: 10.3390/jcm10112351] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The purpose of this study was to evaluate plantar fasciae of healthy subjects and patients with plantar fasciitis by shear wave velocity (SWV) and stiffness with correlation to B-Mode and color Doppler ultrasonography (CDUS) and to establish cut-off values. Methods: This observational study was conducted with the approval of the Institutional Review Boards (IRBs) of our institution. 108 unilateral plantar fasciae were evaluated by including 87 consecutive patients (mean age 51.7; range: 29–82) (66 women and 21 men) with plantar fasciitis and 21 asymptomatic age matched healthy volunteers (mean age 47.3; range: 32–58) (15 women and 6 men). All patients were prospectively imaged between July 2018 and March 2019. B-mode US was used to measure thickness and CDUS to grade vascularity. SWE measurements were repeated 3 times and mean was used for statistical analysis. Results: Mean SWV value in healthy subjects was 6.94 m/s and in patients 4.98 m/s with a mean stiffness value of 152.88 kPa and 93.54 kPa respectively (p < 0.001). For SWV a cut-off value of 6.16 m/s had a specificity of 80.95% and sensitivity of 79.31%. For stiffness a cut-off value of 125.57 kPa had a specificity of 80.95% and sensitivity of 80.46%. No correlation to CDUS was found. The mean thickness of healthy fascias was 3.3 mm (range 2.4–3.9) compared to 6.1 mm (range 2.0–22.0) in plantar fasciitis (p < 0.001) with no correlation to SWV or to stiffness (r² = 0.02, p = 0.06). Conclusion: SWE allows quantitative assessment of plantar fascia stiffness, which decreases in patients with plantar fasciitis. No correlation to the thickness of the plantar fascia was found, therefore it represents an independent factor for the diagnosis of plantar fasciitis and could be helpful in addition to thickness measurement in unclear cases.
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Karanasios S, Korakakis V, Moutzouri M, Drakonaki E, Koci K, Pantazopoulou V, Tsepis E, Gioftsos G. Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review. J Hand Ther 2021; 35:541-551. [PMID: 33814224 DOI: 10.1016/j.jht.2021.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/24/2021] [Accepted: 02/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing. PURPOSE To review the diagnostic accuracy of examination tests used in LET. DESIGN Systematic review following PRISMA-DTA guidelines. METHODS We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET. RESULTS Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with "unclear" or "high risk" of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%). CONCLUSIONS Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42020160402.
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Affiliation(s)
| | | | - Maria Moutzouri
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | - Eleni Drakonaki
- Medical School of the European University Cyprus, Engomi, Nicosia Cyprus
| | - Klaudia Koci
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | | | - Elias Tsepis
- Physiotherapy Department, University of Patras, Greece
| | - George Gioftsos
- Physiotherapy Department, University of West Attica, Egaleo, Greece
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Bai X, Liu Z, Wang B. Shear Wave Elastography (SWE) Evaluation of Asymptomatic Flexor Pollicis Longus Tendon Condition After Volar Plate Fixation for Distal Radius Fracture. Int J Gen Med 2021; 14:187-193. [PMID: 33500654 PMCID: PMC7822231 DOI: 10.2147/ijgm.s290017] [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: 11/02/2020] [Accepted: 12/04/2020] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to evaluate asymptomatic flexor pollicis longus (FPL) tendon condition after volar plate fixation for distal radius fracture using shear wave elastography (SWE). Methods We evaluated 36 distal radius fractures with shear wave elastography to evaluate the FPL tendon after volar plate fixation. Ultrasonography was used to measure the FPL distance to the volar plate in the involved wrists, and the thickness of the FPL tendon in the involved wrists was measured on SWE sonograms taken 12 months postoperatively. Measurements of the involved wrists were compared with those of the intact wrists. The radiographic parameters and Soong grade were collected to analyze the correlation between these indicators and the value of the Young’s modulus and asymptomatic tendon injury. Results The mean values of the Young’s modulus for involved wrist were lower than for intact wrist tendons. The values of the Young’s modulus were correlated with the FPL distance, radial inclination, and Soong grade. FPL tendons of involved wrists exhibited in the majority a yellow (intermediate) SWE signal, compared to intact wrist tendons, which exhibited a red (hard) signal in the vast majority, and there were significant differences between the involved and intact wrist. Conclusion FPL tendon may develop asymptomatically changes after volar locking plate fixation of distal radius fractures, which can be detected by SWE effectively. FPL distance, radial accretion, and Soong grade may be the main causes of asymptomatic FPL tendon erosion.
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Affiliation(s)
- Xiaodong Bai
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Zhenyu Liu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Baojun Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
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Shimoyama D, Shitara H, Hamano N, Ichinose T, Sasaki T, Yamamoto A, Kobayashi T, Tajika T, Takagishi K, Chikuda H. Reliability of shoulder muscle stiffness measurement using strain ultrasound elastography and an acoustic coupler. J Med Ultrason (2001) 2020; 48:91-96. [PMID: 33052492 DOI: 10.1007/s10396-020-01056-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Abnormal increases in muscle tone can be caused by various musculoskeletal disorders. The objective of this study was to evaluate intratester and intertester reliabilities in measuring the stiffness of the shoulder muscles using strain ultrasound elastography (USE) and an acoustic coupler. METHOD Tissue stiffness was measured in the trapezius muscle and in the supraspinatus muscle of healthy young volunteers. RESULTS The mean strain ratios measured by two experienced shoulder surgeons were significantly higher in the trapezius muscle than in the supraspinatus muscle (P < 0.001). Intratester reliability was rated as moderate to substantial for the trapezius muscle and substantial for the supraspinatus muscle. Intertester reliability was substantial for both muscles, with an intraclass correlation coefficient (2,1) of 0.62 [95% confidence interval (CI) 0.28-0.82] for the trapezius muscle and 0.69 (95% CI 0.40-0.86) for the supraspinatus muscle. CONCLUSIONS We found substantial intratester and intertester reliabilities for the trapezius and supraspinatus muscles, suggesting that USE represents a promising modality for measuring the stiffness of shoulder muscles. However, the clinical application of this method will require the development of a device that can standardize the scanning technique to further increase the reliability.
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Affiliation(s)
- Daisuke Shimoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
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Evaluation of plantar fasciopathy shear wave elastography: a comparison between patients and healthy subjects. J Ultrasound 2020; 24:417-422. [PMID: 32418168 DOI: 10.1007/s40477-020-00474-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The aim of this study is to compare elasticity features between patients with plantar fasciitis (PFis) and an asymptomatic healthy control group using shear wave elastography (SWE) and to correlate SWE values with clinical scores. METHODS Consecutive patients diagnosed with PFis and asymptomatic subjects were enrolled in the present study. Both groups underwent clinical, ultrasound (US), and SWE evaluation. A plantar fascia thickness > 4 mm was considered pathognomonic of PFis. SWE stiffness elasticity (Young's modulus in kPa and shear wave velocity in m/s) was measured 1 cm distally from the calcaneal insertion. Correlations with VAS and the 17-Italian Foot Function Index (17-FFI) were determined. RESULTS A total of 19 patients satisfied the inclusion criteria for the patient group and were enrolled in the study, and 21 healthy subjects were used as a control group. Statistically significant differences were found for shear wave velocity between the patient and the control group, with SWE findings of 3.8 (5.1; 1.5) m/s and 4.7 (4.07; 7.04) m/s, respectively (p = 0.006). Strong positive correlations were found between the SWE findings and both the pain and the functional scale (VAS: p = 0.001; FFI: p = 0.012). CONCLUSION SWE allows quantitative assessment of the stiffness of the plantar fascia and can show PFis alterations, increasing the diagnostic performance of B-mode US. In addition, SWE shows a strong correlation with clinical scores, improving patient assessment and follow-up.
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Yoshii Y, Tung WL, Yuine H, Ishii T. Postoperative diagnostic potentials of median nerve strain and applied pressure measurement after carpal tunnel release. BMC Musculoskelet Disord 2020; 21:22. [PMID: 31926552 PMCID: PMC6955092 DOI: 10.1186/s12891-019-3033-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/30/2019] [Indexed: 01/02/2023] Open
Abstract
Bakground The objective of this study is to investigate the prognostic values of median nerve strain and applied pressure measurement for the assessment of clinical recovery after carpal tunnel release. Methods Forty-five wrists, from 45 idiopathic carpal tunnel syndrome patients who treated with open carpal tunnel release, were evaluated by ultrasound. Median nerve strain, pressure applied to the skin, and ratio of pressure-strain were measured at the proximal part of the carpal tunnel. In addition, distal latencies in the motor and sensory nerve conductions studies and cross-sectional area of median nerve were measured. The parameters were compared before and after the open carpal tunnel release. According to patient recovery, the receiver operating characteristic curves were generated to evaluate the prognostic values of the parameters. The areas under the receiver operating characteristic curves were compared among parameters. Results There was a significant increase in the median nerve strain, and significant decreases in the pressure applied to the skin and ratio of pressure-strain after carpal tunnel release (P < 0.01). There were significant decreases in the distal latencies and the cross-sectional area after carpal tunnel release (P < 0.01). The areas under the curves were 0.689, 0.773, 0.811, 0.668, 0.637, and 0.562 for the pressure, strain, pressure-strain ratio, motor latency, sensory latency, and area, respectively. Conclusions The results suggest that elasticity of the median nerve and pressure around the nerve recover quickly after carpal tunnel release. Pressure-strain ratio was the most reliable parameter to reflect clinical recovery. The measurement of strain and applied pressure can be useful indicators to evaluate effectiveness of the carpal tunnel release. Trial registration Registered as NCT04027998 at ClinicalTrials.gov. Retrospectively registered on July 22, 2019.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Tokyo, 300-0395, Japan.
| | - Wen-Lin Tung
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Hiroshi Yuine
- Department of Rehabilitation, Tokyo Medical University Ibaraki Medical Center, Ami, 300-0395, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Tokyo, 300-0395, Japan
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Kim KC, Park JW. Assessing Low Skeletal Mass in Patients Undergoing Hip Surgery: The Role of Sonoelastography. Hip Pelvis 2020; 32:132-141. [PMID: 32953705 PMCID: PMC7476788 DOI: 10.5371/hp.2020.32.3.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/29/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To analyze the utility of sonoelastography—a radiation-free procedure to characterize muscle properties—as an instrument to qualitatively and quantitatively assess the rectus femoris muscle. Materials and Methods Fifty-one consecutive patients who underwent a pelvic computed tomography (CT) exam were enrolled prospectively. The final analysis was conducted using data from 39 patients after 12 were removed due to exclusion criteria (muscle strength could not be measured due to poor cognition [n=11]; too young [n=1]). The potential correlation between average Hounsfield unit (HFU) at the rectus femoris muscle (measured by CT) and muscle quality grade (determined by sonoelastography) was assessed along with a retrospective analysis of the relationship between hand grip strength, knee extensor power, history of intensive care unit stay, length of hospital day and sonoelastographic grade. Results There was a significant correlation between sonoelastographic grade and the average HFU (P<0.001). Furthermore, hand grip strength (P<0.001) and knee extensor power (P<0.001) decreased significantly as the sonoelastographic grade increased. The likelihood of an intensive care unit stay and prevalence of low skeletal mass increased significantly with an increase in sonoelastography grade (P=0.037, P<0.001, respectively). The sensitivity, specificity, and accuracy of sonoelastographic images for predicting low skeletal mass were 77.3%, 100%, and 87.5%, respectively. Conclusion Sonoelastography advantages, including the lack of radiation and greater accessibility, may make it a valuable alternative to qualitatively and quantitatively identify sarcopenia and low skeletal mass.
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Affiliation(s)
- Ki-Choul Kim
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Jae-Wook Park
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
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20
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Abd Ellah M, Taljanovic M, Klauser A. Musculoskeletal elastography. TISSUE ELASTICITY IMAGING 2020:197-224. [DOI: 10.1016/b978-0-12-809662-8.00009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Zhu B, You Y, Xiang X, Wang L, Qiu L. Assessment of common extensor tendon elasticity in patients with lateral epicondylitis using shear wave elastography. Quant Imaging Med Surg 2020; 10:211-219. [PMID: 31956543 DOI: 10.21037/qims.2019.10.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background To investigate the role of shear wave elastography (SWE) in patients with lateral epicondylitis (LE) by assessing the common extensor tendon (CET) elasticity. Methods A total of 62 unilateral LE patients were enrolled. Shear wave speed (SWS) and the thickness of CET in both elbows, along with the involved elbows with pre- and post-treatment, were obtained by SWE. The differences between groups, inter- and intra-observer agreements, and diagnostic accuracy were analyzed with a paired t-test, intraclass correlation coefficients (ICCs), and receiver operator characteristic (ROC) curve, respectively. Results LE patients had significantly lower SWS on lesion sides compared to healthy elbows (P<0.05). The SWS of involved elbows were significantly higher after non-operation treatment than before treatment. The inter- and intra-observer agreements were excellent (ICCs: 0.900-0.993) for SWE measurements. Moreover, a 12.2 m/s cutoff value of mean SWS (C mean) for discriminating LE patients from healthy subjects revealed a sensitivity and specificity of 93% and 93%, respectively. Conclusions SWE is a valid imaging technique for the diagnosis of LE and monitoring of the treatment effect. Future studies are essential for investigating the correlations among clinical examinations, conventional ultrasound, and SWE.
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Affiliation(s)
- Bihui Zhu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yingqi You
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xi Xiang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Liyun Wang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Li Qiu
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, China
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Sederberg M, Liem B, Tarkhan A, Gessel T, LaCourse M, Latzka E. Brief Ultrasound-Aided Teaching to Improve the Accuracy and Confidence of Resident Musculoskeletal Palpation. PM R 2019; 12:391-396. [PMID: 31448538 DOI: 10.1002/pmrj.12246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/18/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multiple studies demonstrate poor musculoskeletal palpation accuracy of physiatry residents. With the growing use of ultrasound clinically, it could serve as a powerful educational tool. However, there are no published studies examining the efficacy of ultrasound-aided education at the bedside, where much learning takes place during postgraduate training. OBJECTIVE To determine if brief ultrasound-aided teaching improves residents' accuracy and confidence of musculoskeletal palpation. DESIGN Before/After Trial. SETTING Academic Institution. PARTICIPANTS Ten physical medicine and rehabilitation residents were voluntary participants. INTERVENTION Each resident was given a survey to assess confidence in palpating the hook of the hamate and medial calcaneal tubercle. They then attempted to palpate and place a marker over these two structures in a model patient. Marker placement accuracy was verified by ultrasound. Faculty spent less than 1 minute per landmark, sonographically teaching its correct localization. The resident, after moving to a new model patient, was then re-tested on accurate marker placement for both landmarks. A repeat survey to assess confidence was administered. MAIN OUTCOME MEASUREMENTS Preintervention and postintervention accuracy and confidence of correct localization of both landmarks. RESULTS We used McNemar's and Wilcoxon's tests to determine whether the intervention improved the location accuracy and confidence of successful palpation, respectively. Confidence level of correct localization of two landmarks improved on average from 4.3 to 8.15 on a scale of 10 after intervention. Of 20 palpation attempts, 11 correctly placed the marker postintervention after an incorrect placement, 8 made no change, and one changed from correct to incorrect placement. The odds of improvement in accuracy was 11 (95% confidence interval [CI] 1.60-473.47, P < .01). Both tests showed significant improvements after the intervention at the significance level of .05. CONCLUSIONS Brief, ultrasound-aided teaching increases accuracy and confidence of residents' musculoskeletal palpation.
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Affiliation(s)
- Mark Sederberg
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Brian Liem
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Trevor Gessel
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Matthew LaCourse
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Erek Latzka
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Ok N, Agladioglu K, Gungor HR, Akkaya N, Akkaya S. Strain Ratio Measurements of Patellar and Achilles Tendons With Different Reference Regions in Healthy Volunteers. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2027-2033. [PMID: 31104866 DOI: 10.1016/j.ultrasmedbio.2019.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/12/2019] [Accepted: 04/29/2019] [Indexed: 06/09/2023]
Abstract
Strain ratio measurements of tendons vary because of the reference tissue selection. The main purpose of this study is to highlight, in detail, the numeric variability attributable to the use of various reference materials on strain ratio measurements of patellar and Achilles tendons. Measurements were performed at the proximal, middle and distal thirds of the patellar and Achilles tendons on the dominant site of healthy volunteers. A total of 3 references were used: the Hoffa's fat pad for the patellar tendon, the Kager's fat pad for the Achilles tendon, subcutaneous tissue and Aquaflex gel pads (Parker Laboratories, Fairfield, NJ, USA) for both tendons. Although the same methods were used by the same physician for each tendon site on repeated measurements, strain ratio values had numeric variability with various reference materials in each measurement. Therefore, comparison of numeric strain ratio results of various studies with various reference materials could confuse the clinical interpretations of these numeric data, and, using a reference material with standard stiffness like Aquaflex ultrasound gel pads, should be considered by verifying these results with further studies.
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Affiliation(s)
- Nusret Ok
- Pamukkale University Medical Faculty, Department of Orthopedics and Traumatology, Pamukkale, Denizli, Turkey
| | - Kadir Agladioglu
- Medistate Kavacik Hospital, Department of Radiology, Kavacık, Beykoz, Istanbul, Turkey
| | - Harun R Gungor
- Pamukkale University Medical Faculty, Department of Orthopedics and Traumatology, Pamukkale, Denizli, Turkey.
| | - Nuray Akkaya
- Pamukkale University Medical Faculty, Department of Physical and Rehabilitation Medicine, Pamukkale, Denizli, Turkey
| | - Semih Akkaya
- Denipol Hospital, Department of Orthopedics and Traumatology, Merkezefendi, Denizli, Turkey
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Brage K, Hjarbaek J, Kjaer P, Ingwersen KG, Juul-Kristensen B. Ultrasonic strain elastography for detecting abnormalities in the supraspinatus tendon: an intra- and inter-rater reliability study. BMJ Open 2019; 9:e027725. [PMID: 31072860 PMCID: PMC6527995 DOI: 10.1136/bmjopen-2018-027725] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The reliability of ultrasonic strain elastography (SEL) used to detect abnormalities in the supraspinatus tendon is unclear. Thus, the aim of this study was to investigate the reliability of SEL in the supraspinatus tendon. DESIGN An intra-rater and inter-rater reliability study. SETTING A single-centre study conducted at the University of Southern Denmark. PARTICIPANTS Twenty participants with shoulder pain and MRI-verified supraspinatus tendinosis and 20 asymptomatic participants (no MRI). PRIMARY AND SECONDARY OUTCOME MEASURES Raw values (RAW) and ratios (deltoid muscle (DELT) and gel pad (GEL) as reference tissues) were calculated and mean values of measurements from three regions of the supraspinatus tendon were reported. Colour scale ratings and number of yellow/red lesions from the three areas were also included. RESULTS Intra-rater reliability showed intraclass correlation coefficients (ICCs) for RAW, DELT and GEL: 0.97 (minimal detectable change (MDC): 0.28 (6.36% of the mean)), 0.89 (MDC: 2.91 (20.37%)) and 0.73 (MDC: 1.61 (58.82%)), respectively. The ICCs for inter-rater reliability were 0.89 (MDC: 0.47 (10.53%)), 0.78 (MDC: 3.69 (25.51%)) and 0.70 (MDC: 1.75 (62.63%)), respectively.For colour scale ratings, intra-rater reliability (linear weighted kappa) ranged from 0.76 to 0.79, with the inter-rater reliability from 0.71 to 0.81. For the number of lesions, intra-rater reliability ranged from 0.40 to 0.82 and inter-rater reliability from 0.24 to 0.67. CONCLUSIONS Intra-rater and inter-rater reliability were excellent for raw values and for ratios with deltoid muscle as the reference tissue, and good for ratios with gel pad as the reference tissue. The reliability of colour scale ratings was substantial-to-almost perfect, and for the number of lesions fair-to-almost perfect.Although high reliability was found, validity and responsiveness of these elastographic methods needs further investigation. ETHICS APPROVAL The study protocol was approved by the Ethics Committee for the Region of South Denmark (S-20160115) and reported to the Danish Data Protection Agency (2014-41-3266).
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Affiliation(s)
- K Brage
- Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - John Hjarbaek
- Department of Radiology, Musculoskeletal section, Odense Universitetshospital, Odense, Denmark
| | - Per Kjaer
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Birgit Juul-Kristensen
- Institute of Sports Science and Clinical Biomechanics, Research Unit for Musculoskeletal Function and Physiotherapy, Odense, Denmark
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The effectiveness of Biomechanical Taping Technique on visual analogue scale, static maximum handgrip strength, and Patient Rated Tennis Elbow Evaluation of patients with lateral epicondylalgia: A cross-over study. J Bodyw Mov Ther 2019; 23:405-416. [DOI: 10.1016/j.jbmt.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/11/2018] [Accepted: 05/26/2018] [Indexed: 12/11/2022]
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Vasishta A, Kelkar A, Joshi P, Hapse R. The value of sonoelastography in the diagnosis of supraspinatus tendinopathy-a comparison study. Br J Radiol 2019; 92:20180951. [PMID: 30689398 DOI: 10.1259/bjr.20180951] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE: This study assessed the association between tendon stiffness on sonoelastography and grades of tendinopathy on MRI in patients with supraspinatus tendinopathy. METHODS: 25 consecutive adult patients with clinically suspected supraspinatus tendinopathy and no prior history of trauma referred for MRI of the shoulder were selected for this study. The supraspinatus tendinopathy was graded in consonance with MRI findings (Grade I, normal; Grade II, mild tendinopathy; Grade III, moderate tendinopathy; and Grade IV, marked tendinopathy). Strain ratios were evaluated. Spearman rank correlation test was used, to analyze the association of the MRI grade with strain ratios. RESULTS: Out of 25 patients, Grade I changes on MRI were found in 5 patients (20.0%), Grade II tendinopathy in 13 patients (52.0%), Grade III in 6 patients (24.0%), and Grade IV in 1 patient (4.0%). The mean sonoelastography strain ratio of supraspinatus tendons were 0.76 ± 0.32 in patients with Grade I, 0.59 ± 0.40 in Grade II, 0.31 ± 0.10 in Grade III and 0.15 ± 0.02 in Grade IV patients respectively. The strain ratios showed good correlation with the MRI grade p < 0.05. CONCLUSION: We compared the MRI findings of supraspinatus tendinopathy with sonoelastography strain ratios. Sonoelastography showed good correlation with MRI. ADVANCES IN KNOWLEDGE: Sonoelastography in supraspinatus tendinopathy may help in predicting improvement or worsening of the tendon health at the tissue level. Therefore, there is a possibility that it has use in the rehabilitation of professionals suffering from supraspinatus tendinopathy.
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Affiliation(s)
- Aishvarya Vasishta
- 1 Department of Radiodiagnosis and Imaging, Bharati Hospital and Research Center, Dhankawadi , Pune , India
| | - Abhimanyu Kelkar
- 1 Department of Radiodiagnosis and Imaging, Bharati Hospital and Research Center, Dhankawadi , Pune , India
| | - Priscilla Joshi
- 1 Department of Radiodiagnosis and Imaging, Bharati Hospital and Research Center, Dhankawadi , Pune , India
| | - Renuka Hapse
- 1 Department of Radiodiagnosis and Imaging, Bharati Hospital and Research Center, Dhankawadi , Pune , India
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Salman M, Sabra KG. Assessing non-uniform stiffening of the achilles tendon noninvasively using surface wave. J Biomech 2019; 82:357-360. [PMID: 30473135 DOI: 10.1016/j.jbiomech.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/04/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
Currently, noninvasive cost-effective techniques capable of quantifying non-uniform degradation of tendon's mechanical and structural properties associated with localized tendon injuries are not readily available. This study demonstrates the applicability of a simple surface-wave elastography (SURF-E) method for assessing the stiffness of the Achilles Tendon by measuring the propagation velocity of surface waves along the tendon in a much broader range of values than currently available Ultrasound-based or MRI-based elastography methods do. Results from this study confirm the non-uniform stiffening of the AT during passive ankle dorsiflexions.
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Affiliation(s)
| | - Karim G Sabra
- Kennesaw State University, Georgia Institute of Technology.
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Shin M, Hahn S, Yi J, Lim YJ, Bang JY. Clinical Application of Real-Time Sonoelastography for Evaluation of Medial Epicondylitis: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:246-254. [PMID: 30352727 DOI: 10.1016/j.ultrasmedbio.2018.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to evaluate the diagnostic potential of real-time sonoelastography (RSE) in medial epicondylitis by comparing clinically diagnosed patients and patients without medial elbow pain. From July 2016 to December 2017, gray-scale sonographic findings (swelling, cortical irregularity, hypo-echogenicity, calcification and tear), color Doppler findings (hyperemia) and sonoelastographic findings (elastographic grade on a 3-point visual scale and strain ratio from two regions of interest) for 63 elbows of 56 patients were compared. Twenty-four patients with 29 imaged elbows were clinically diagnosed with medial epicondylitis, and 32 patients with 34 imaged elbows had no medial elbow pain. Cortical irregularity, hypo-echogenicity, calcification, elastographic grade and strain ratio revealed significant differences (p < 0.05). Among these, strain ratio had the highest diagnostic performance (area under the curve: 0.985). Real-time sonoelastography, which can obtain both elastographic grade and strain ratio, is valuable as a supplementary tool in the diagnosis of medial epicondylitis.
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Affiliation(s)
- Minwoo Shin
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea.
| | - Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Yun-Jung Lim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
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29
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Interobserver variability and stiffness measurements of normal common extensor tendon in healthy volunteers using shear wave elastography. Skeletal Radiol 2019; 48:137-141. [PMID: 30006828 DOI: 10.1007/s00256-018-3021-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/04/2018] [Accepted: 06/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purposes of our study are to determine the quantitative elasticity values of normal common extensor tendon (CET) and to assess the interobserver variability of stiffness measurements using shear wave elastography (SWE). MATERIALS AND METHODS A total of 60 CETs of 30 (15 female, 15 male, mean age 30.2 years) healthy volunteers without any symptoms of lateral epicondylitis were examined by two radiologists. Age, sex, height, weight, body mass index (BMI), and dominant hand of all participants were noted. The first observer performed B-mode and SWE imaging, and the second observer performed only SWE imaging. Tendon thickness and stiffness values in kPa were measured. RESULTS The mean thickness of CETs was 3.57 ± 0.36 mm. The mean stiffness values of CETs for two observers were 45.28 ± 9.82 kPa and 45.80 ± 9.72 kPa respectively. Tendon thickness had a weak correlation with weight (r = 0.281, p = 0.03), and moderate correlation with stiffness values (r = 0.429, p < 0.001). The mean interobserver difference of CET stiffness measurements was -0.5% of the mean CET stiffness values. Range of measurement error, defined as 95% limits of agreement, was ±23.5%. There was no significant difference between absolute values of interobserver measurements (p = 0.741). CONCLUSION Shear wave elastography is a reproducible imaging technique for the evaluation of CET elasticity and the standard stiffness values of normal CET can be used as reference data to differentiate normal from pathological tissues.
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Ooi CC, Schneider M, Malliaras P, Png MA, Chadwick M, Jones D, Venkatanarasimha N, Connell D. Real-time sonoelastography evaluation of the Achilles tendon following ultrasound-guided platelet-rich plasma injection and eccentric exercise for the treatment of refractory Achilles tendinopathy. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 27:138-147. [PMID: 32549893 DOI: 10.1177/1742271x18818608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022]
Abstract
The objective of this study was to investigate the feasibility of using sonoelastography to depict Achilles tendon stiffness after platelet-rich plasma injection and eccentric exercise for chronic Achilles tendinopathy, and to correlate sonoelastography findings with clinical outcome up to 12 months after treatment. Forty-five Achilles tendons from 45 patients (33 males, 12 females; mean age 51 years) were examined using sonoelastography and ultrasound at baseline, 4-6 weeks, 6 months and 12 months post-treatment. The strain ratio (between Achilles tendon and Kager's fat) during sonoelastography was obtained. The proportion of tendons with hypoechogenicity and neovascularity were documented. Clinical outcomes were assessed by the Victorian Institute of Sport Assessment-Achilles questionnaire and correlated with sonographic findings. The Victorian Institute of Sport Assessment-Achilles improved significantly from 38.4 (±14.1) at baseline, 77.2 (±12.5) at 6 months (p < 0.001) to 81.2 (±10.8) at 12 months (p < 0.001). The strain ratio values were 2.16 (±1.02) at baseline, 2.03 (±0.67) at 4-6 weeks, 1.81 (±0.62) at 6 months and 1.19 (±0.34) at 12 months with a significant reduction observed at 6 months (p = 0.006) and 12 months (p < 0.001). At 12-month evaluation, none of the tendons regained a normal echotexture. Strain ratio demonstrated a moderately good inverse correlation with Victorian Institute of Sport Assessment-Achilles (r = -0.610, p<0.001) while B-mode and Doppler ultrasound did not show a significant correlation (r = -0.041, p = 0.817, and r = -0.116, p = 0.514). Achilles tendon stiffness shows moderately good correlation with clinical symptom at 12-month post-treatment. Sonoelastography using strain ratio could be a promising ancillary tool for monitoring Achilles tendon healing after treatment.
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Affiliation(s)
- Chin Chin Ooi
- Division of Radiological Sciences, Singapore General Hospital, Singapore, Singapore.,Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Imaging at Olympic Park, AAMI Park, Melbourne, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Peter Malliaras
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Imaging at Olympic Park, AAMI Park, Melbourne, Australia.,Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary, University of London, London, UK
| | - Meng Ai Png
- Division of Radiological Sciences, Singapore General Hospital, Singapore, Singapore
| | | | - Donna Jones
- Imaging at Olympic Park, AAMI Park, Melbourne, Australia
| | | | - David Connell
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Imaging at Olympic Park, AAMI Park, Melbourne, Australia
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Sconfienza LM, Albano D, Allen G, Bazzocchi A, Bignotti B, Chianca V, Facal de Castro F, Drakonaki EE, Gallardo E, Gielen J, Klauser AS, Martinoli C, Mauri G, McNally E, Messina C, Mirón Mombiela R, Orlandi D, Plagou A, Posadzy M, de la Puente R, Reijnierse M, Rossi F, Rutkauskas S, Snoj Z, Vucetic J, Wilson D, Tagliafico AS. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol 2018; 28:5338-5351. [PMID: 29876703 DOI: 10.1007/s00330-018-5474-3] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/02/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To update the 2012 European Society of Musculoskeletal Radiology (ESSR) clinical consensus guidelines for musculoskeletal ultrasound referral in Europe. METHODS Twenty-one musculoskeletal imaging experts from the ESSR participated in a consensus study based on a Delphic process. Two independent (non-voting) authors facilitated the procedure and resolved doubtful issues. Updated musculoskeletal ultrasound literature up to July 2017 was scored for shoulder, elbow, wrist/hand, hip, knee, and ankle/foot. Scoring of ultrasound elastography was included. The strength of the recommendation and level of evidence was scored by consensus greater than 67% or considered uncertain when the consensus was consensus less than 67%. RESULTS A total of 123 new papers were reviewed. No evidence change was found regarding the shoulder. There were no new relevant articles for the shoulder, 10 new articles for the elbow, 28 for the hand/wrist, 3 for the hip, 7 for the knee, and 4 for the ankle/foot. Four new evidence levels of A were determined, one for the hip (gluteal tendons tears), one for the knee (meniscal cysts), one for the ankle (ankle joint instability), and one for the foot (plantar plate tear). There was no level A evidence for elastography, although for Achilles tendinopathy and lateral epicondylitis evidence level was B with grade 3 indication. CONCLUSIONS Four new areas of level A evidence were included in the guidelines. Elastography did not reach level A evidence. Whilst ultrasound is of increasing importance in musculoskeletal medical practice, the evidence for elastography remains moderate. KEY POINTS • Evidence and expert consensus shows an increase of musculoskeletal ultrasound indications. • Four new A evidence levels were found for the hip, knee, ankle, and foot. • There was no level A evidence for elastography.
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Affiliation(s)
- Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy.
| | - Domenico Albano
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Georgina Allen
- Department of Radiology, St Lukes Radiology Oxford Ltd, Oxford, UK
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, "Rizzoli" Orthopaedic Institute, Bologna, Italy
| | - Bianca Bignotti
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16132, Genova, Italy
| | - Vito Chianca
- Department of Advanced Biomedical Sciences, Università degli studi Federico II, via Pansini 5, 80131, Napoli, Italy
| | | | | | - Elena Gallardo
- Department of Radiology, University Hospital Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - Jan Gielen
- Radiology and S.P.O.R.T.S. Department, Antwerp University and Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Andrea Sabine Klauser
- Department of Radiology, Medical University Innsbruck, Section Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16132, Genova, Italy
- Ospedale Policlinico San Martino, Genova, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milano, Italy
| | | | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milano, Italy
| | - Rebeca Mirón Mombiela
- Hospital General Universitario de Valencia, Ave. Tres Cruces 2, 46014, Valencia, Spain
- Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain
| | - Davide Orlandi
- S.C. Diagnostica per Immagini e Ecografia Interventistica, Ospedale Evangelico Internazionale, Corso Solferino 1A, 16122, Genova, Italy
| | - Athena Plagou
- Department of Radiology, Private Institution of Ultrasonography, Athens, Greece
| | - Magdalena Posadzy
- Department of Radiology, W. Dega Orthopaedic and Rehabilitation University Hospital of Karol Marcinkowski University of Medical Sciences, Poznan, Poland
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Federica Rossi
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16132, Genova, Italy
| | - Saulius Rutkauskas
- Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania
| | - Ziga Snoj
- Ljubljana University Medical Centre, Clinical Institute of Radiology, Ljubljana, Slovenia
| | - Jelena Vucetic
- Hospital General Universitario de Valencia, Ave. Tres Cruces 2, 46014, Valencia, Spain
- Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain
| | - David Wilson
- Department of Radiology, St Lukes Radiology Oxford Ltd, Oxford, UK
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, 16132, Genova, Italy
- Ospedale Policlinico San Martino, Genova, Italy
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Prado-Costa R, Rebelo J, Monteiro-Barroso J, Preto AS. Ultrasound elastography: compression elastography and shear-wave elastography in the assessment of tendon injury. Insights Imaging 2018; 9:791-814. [PMID: 30120723 PMCID: PMC6206379 DOI: 10.1007/s13244-018-0642-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/22/2018] [Accepted: 06/21/2018] [Indexed: 12/27/2022] Open
Abstract
Ultrasound elastography (USE) is a recent technology that has experienced major developments in the past two decades. The assessment of the main mechanical properties of tissues can be made with this technology by characterisation of their response to stress. This article reviews the two major techniques used in musculoskeletal elastography, compression elastography (CE) and shear-wave elastography (SWE), and evaluates the studies published on major electronic databases that use both techniques in the context of tendon pathology. CE accounts for more studies than SWE. The mechanical properties of tendons, particularly their stiffness, may be altered in the presence of tendon injury. CE and SWE have already been used for the assessment of Achilles tendons, patellar tendon, quadriceps tendon, epicondylar tendons and rotator cuff tendons and muscles. Achilles tendinopathy is the most studied tendon injury with USE, including the postoperative period after surgical repair of Achilles rupture tendon. In relation to conventional ultrasound (US), USE potentially increases the sensitivity and diagnostic accuracy in tendinopathy, and can detect pathological changes before they are visible in conventional US imaging. Several technical limitations are recognised, and standardisation is necessary to ensure repeatability and comparability of the results when using these techniques. Still, USE is a promising technique under development and may be used not only to promote an early diagnosis, but also to identify the risk of injury and to support the evaluation of rehabilitation interventions. KEY POINTS: • USE is used for the assessment of the mechanical properties of tissues, including the tendons. • USE increases diagnostic performance when coupled to conventional US imaging modalities. • USE will be useful in early diagnosis, tracking outcomes and monitoring treatments of tendon injury. • Technical issues and lack of standardisation limits USE use in the assessment of tendon injury.
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Affiliation(s)
- Rui Prado-Costa
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Rebelo
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal.
| | - João Monteiro-Barroso
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Sofia Preto
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal
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Lungu E, Grondin P, Tétreault P, Desmeules F, Cloutier G, Choinière M, Bureau NJ. Ultrasound-guided tendon fenestration versus open-release surgery for the treatment of chronic lateral epicondylosis of the elbow: protocol for a prospective, randomised, single blinded study. BMJ Open 2018; 8:e021373. [PMID: 29886446 PMCID: PMC6009557 DOI: 10.1136/bmjopen-2017-021373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Chronic lateral epicondylosis (CLE) of the elbow is a prevalent condition among middle-aged people with no consensus on optimal care management but for which surgery is generally accepted as a second intention treatment. Among conservative treatment options, ultrasound (US)-guided fenestration has shown encouraging results that should be explored before surgery is considered. The primary objective of this study is to compare the efficacy of US-guided fenestration with open-release surgery in patients with failure to improve following a minimum 6 months of conservative treatment. METHODS AND ANALYSIS This study protocol entails a two-arm, single-blinded, randomised, controlled design. Sixty-four eligible patients with clinically confirmed CLE will be assigned to either US-guided fenestration or open-release surgery. Fisher's exact test will be used to compare the proportion of patients reporting a change of 11/100 points or more in the Patient Rated Tennis Elbow Evaluation score at 6 months, according to an intention-to-treat analysis. Secondary analyses will compare the two treatment groups in terms of pain and disability, functional limitations at work, pain-free grip strength, medication burden, patients' global impression of change and level of satisfaction at 6 weeks, 3, 6 and 12 months, using mixed linear models for repeated measures or Fisher's exact test, as appropriate. Finally, recursive partitioning analyses will investigate US and elastography parameters as predictors of treatment success at 6 and 12 months. This data will contribute to evidence-based treatment guidelines for CLE and explore the value of imaging biomarkers to improve risk stratification plans and assist clinicians. ETHICS AND DISSEMINATION The study has been approved by the Research Ethics Board of our institution on 23 March 2016 (REB 15.327). In case of important protocol modifications, a new version of the protocol with appropriate amendments will be submitted to the REB for approval. Study results will be published in peer-reviewed journals and presented at local, national and international conferences. TRIAL REGISTRATION NUMBER NCT02710682.
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Affiliation(s)
- Eugen Lungu
- Department of Radiology, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Quebec, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Grondin
- Department of Surgery, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Quebec, Canada
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Tétreault
- Department of Surgery, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Quebec, Canada
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - François Desmeules
- Research Center, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Quebec, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Guy Cloutier
- Department of Radiology, Radio-oncology and Nuclear Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Manon Choinière
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
- Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie J Bureau
- Department of Radiology, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Quebec, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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Manzoor I, Bacha R, Gilani SA. Diagnostic accuracy of sonoelastography in different diseases. J Ultrason 2018; 18:29-36. [PMID: 29844938 PMCID: PMC5911716 DOI: 10.15557/jou.2018.0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 12/31/2022] Open
Abstract
The objective of this study was to evaluate the diagnostic accuracy of sonoelastography in patients of primary and secondary health care settings. Google scholar, PubMed, Medline, Medscape, Wikipedia and NCBI were searched in October 2017 for all original studies and review articles to identify the relevant material. Two reviewers independently selected articles for evaluation of the diagnostic accuracy of sonoelastography in different diseases based on titles and abstracts retrieved by the literature search. The accuracy of sonoelastography in different diseases was used as the index text, while B-mode sonography, micro pure imaging, surgery and histological findings were used as reference texts. Superficial lymph nodes, neck nodules, malignancy in thyroid nodules, benign and malignant cervical lymph nodes, thyroid nodules, prostate carcinoma, benign and malignant breast abnormalities, liver diseases, parotid and salivary gland masses, pancreatic masses, musculoskeletal diseases and renal disorders were target conditions. The data extracted by the two reviewers concerning selected study characteristics and results were presented in tables and figures. In total, 46 studies were found for breast masses, lymph nodes, prostate carcinoma, liver diseases, salivary and parotid gland diseases, pancreatic masses, musculoskeletal diseases and renal diseases, and the overall sensitivity of sonoelastography in diagnosing all these diseases was 83.14% while specificity was 81.41%. This literature review demonstrates that sonoelastography is characterized by high sensitivity and specificity in diagnosing different disorders of the body.
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Affiliation(s)
| | - Raham Bacha
- (UIRSMIT) FAHS Department, University of Lahore, Lahore, Pakistan
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Arslan S, Karahan AY, Oncu F, Bakdik S, Durmaz MS, Tolu I. Diagnostic Performance of Superb Microvascular Imaging and Other Sonographic Modalities in the Assessment of Lateral Epicondylosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:585-593. [PMID: 28850740 DOI: 10.1002/jum.14369] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this study was to compare the diagnostic performance of different sonographic modalities for diagnosing lateral epicondylosis. METHODS A total of 50 symptomatic and 50 asymptomatic common extensor tendons in 44 patients with lateral epicondylosis, and 25 healthy participants were prospectively examined by B-mode sonography, color Doppler imaging, power Doppler imaging, Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan), and strain elastography. We evaluated blood flow in common extensor tendons by using a grading system with color Doppler imaging, power Doppler imaging, and SMI. The diagnostic performance of the modalities was compared. RESULTS When a cutoff value of hypoechogenicity was used for the mean strain ratio, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates were 92.0%, 94%.0, 93.9%, 92.2%, and 93.0%, respectively. When a cutoff point of grade 1 was used, the sensitivity, specificity, PPV, NPV, and accuracy rates were 26.0%, 10.0%, 10.0%, 57.5%, and 63.0, for color Doppler imaging; 40.0%, 10.0%, 10.0%, 62.5%, and 70.0% for power Doppler imaging; and 84.0%, 94.0%, 93.0%, 85.5%, and 89.0% for SMI. When a cutoff value of 3.94 was used for the mean strain ratio, the sensitivity, specificity, PPV, NPV, and accuracy rates were 78.0%, 92.0%, 90.7%, 80.7%, and 85.0%, respectively. A statistically significant correlation was detected between SMI, strain elastography, and visual analog scale scores (P < .001). CONCLUSIONS The combination of SMI and B-mode sonography was found to have excellent diagnostic performance for lateral epicondylosis. Neovascularzation in patients' tendons with lateral epicondylosis was identified much better with SMI compared to color or power Doppler imaging.
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Affiliation(s)
- Serdar Arslan
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Ali Yavuz Karahan
- Department of Physical Therapy and Rehabilitation, Usak University School of Medicine, Usak, Turkey
| | - Fatih Oncu
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Suleyman Bakdik
- Department of Radiology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Mehmet Sedat Durmaz
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Ismet Tolu
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
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36
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Evaluation of sonoelastography in Achilles tendon of healthy volunteers and patients with symptomatic Achilles tendon. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Lin CY, Ooi CC, Chan E, Chew KT. Emerging Technological Advances in Musculoskeletal Ultrasound. PM R 2018; 10:112-119. [PMID: 29413117 DOI: 10.1016/j.pmrj.2017.08.444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/21/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Cindy Y Lin
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Chin Chin Ooi
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Eric Chan
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Kelvin T Chew
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
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Fusini F, Langella F, Busilacchi A, Tudisco C, Gigante A, Massé A, Bisicchia S. Real-time sonoelastography: principles and clinical applications in tendon disorders. A systematic review. Muscles Ligaments Tendons J 2018; 7:467-477. [PMID: 29387640 DOI: 10.11138/mltj/2017.7.3.467] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Sonoelastography (SE) is a new ultrasound-based method adopted in an increased number of scientific reports to analyse normal and pathological tendons. The aim of this study is to provide a systematic overview of clinical applications of SE in normal and pathological tendons. Methods A systematic research of PubMed, Ovid, and Cochrane Library electronic databases was performed according to PRISMA guideline. Two Authors searched and evaluated the articles independently; a third Author was involved to solve any disagreement. The Oxford Level of Evidence (LoE) was used to assess each article. Results There is an increasing interest in the application of SE in the evaluation of healthy and diseased tendons. Many different tendons are amenable for SE evaluation, such as the Achilles and patellar tendons, rotator cuff, common extensor tendons, quadriceps tendon, and the plantar fascia. Conclusion SE appears to be a very useful diagnostic tool, in particular in tendon pathology. This is a dynamic examination, provides an immediate evaluation of the tissue elasticity, and may be useful in recognizing tendon abnormalities and in implementing the information available with conventional US. Level of evidence IV.
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Affiliation(s)
- Federico Fusini
- University of Turin, School of Orthopaedic and Traumatology, Turin, Italy
| | - Francesco Langella
- Clinical Orthopedics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Busilacchi
- Clinical Orthopedics, Department of Molecular Pathology and Innovative Therapies, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Cosimo Tudisco
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Gigante
- Clinical Orthopedics, Department of Molecular Pathology and Innovative Therapies, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Massé
- University of Turin, School of Orthopaedic and Traumatology, Turin, Italy
| | - Salvatore Bisicchia
- Orthopaedics and Traumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy
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Ultrasound elastography in tendon pathology: state of the art. Skeletal Radiol 2017; 46:1643-1655. [PMID: 28765991 DOI: 10.1007/s00256-017-2726-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 06/30/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
Elastography assesses the biomechanical and structural properties of tissues by measuring their stiffness. Despite promising results, elastography has not yet earned its place in the daily practice of musculoskeletal radiologists. The purpose of this article is to present and examine the data available to date on ultrasound elastography of the tendons through a review of the literature to provide musculoskeletal radiologists with an overview that may help them better understand and use elastography routinely. The most common techniques in ultrasound elastography are described. Then, the aspects of the physiologic and pathologic tendon are presented and discussed. One must make this technique one's own to better apprehend its contribution to the musculoskeletal imaging field, while bearing in mind that further research will be required before admitting elastography as a reliable and validated tool able to optimize our daily clinical practice.
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Inal M, Tan S, Demirkan S, Burulday V, Gündüz Ö, Örnek K. Evaluation of Optic Nerve with Strain and Shear Wave Elastography in Patients with Behçet's Disease and Healthy Subjects. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1348-1354. [PMID: 28450035 DOI: 10.1016/j.ultrasmedbio.2017.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 06/07/2023]
Abstract
The objective of this study was to investigate the elasticity characteristics of the optic nerve using strain and shear wave elastography in patients with Behçet's disease and to compare the results with those of healthy volunteers. Forty-six optic nerves from patients with Behçet's disease and 54 optic nerves from healthy volunteers were investigated prospectively in this study using strain and shear wave elastography. There was a statistically significant difference in terms of elasticity patterns between patients and healthy volunteers (p < 0.001). Elastographic images of healthy volunteers revealed most optic nerves to be type 3 (51.8%); however, type 2 (40.7%) and type 1 (7.5%) were also observed. Elastographic examination of Behçet's disease patients revealed type 2 in 52.2%, type 1 in 43.5% and type 3 in 4.3% of patients. Statistically significant differences were observed between patients and healthy volunteers in the analysis of shear wave elastography values (p < 0.001). Receiver operating characteristic curve analysis was perfect (0.933) (95% CI = 0.885-0.980), and a cutoff value of 16.5 kPa shear had very high sensitivity and specificity for the patient group. Strain and shear wave elastography findings for the optic nerves of patients with Behçet's disease were significantly different from those for healthy volunteers.
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Affiliation(s)
- Mikail Inal
- Department of Radiology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey.
| | - Sinan Tan
- Department of Radiology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
| | - Veysel Burulday
- Department of Radiology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
| | - Özgür Gündüz
- Department of Dermatology and Venerology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
| | - Kemal Örnek
- Department of Ophtalmology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
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41
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Authors' Response to a Letter to the Editor on Radial Extracorporeal Shockwave in the Management of Lateral Epicondylitis. Am J Phys Med Rehabil 2017; 97:e11-e12. [PMID: 28657918 DOI: 10.1097/phm.0000000000000784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yoshii Y, Tung WL, Ishii T. Strain and Morphological Changes of Median Nerve After Carpal Tunnel Release. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1153-1159. [PMID: 28240782 DOI: 10.7863/ultra.16.06070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/17/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Characterization of the changes of ultrasound parameters after carpal tunnel release may be useful for clarifying the effectiveness or the recovery process of the carpal tunnel syndrome treatment. We evaluated strain and morphological changes of the median nerve before and after carpal tunnel release in carpal tunnel syndrome patients. METHODS Twenty-two wrists of 20 idiopathic carpal tunnel syndrome patients who underwent open carpal tunnel release were evaluated by ultrasound. Cross-sectional images of the median nerve were obtained at the proximal carpal tunnel. The cross-sectional area, perimeter, aspect ratio of the minimum enclosing rectangle, and strain of the median nerve were measured and compared before and after carpal tunnel release. According to the patient's recovery, the areas under the receiver operating characteristic curves (AUCs) were compared among the parameters. RESULTS After carpal tunnel release, the area and perimeter significantly decreased, and the strain significantly increased compared with before carpal tunnel release. There were no significant changes in the aspect ratio after carpal tunnel release. The AUCs were 0.663, 0.643, 0.543, and 0.731 for the area, perimeter, aspect ratio, and strain, respectively. CONCLUSIONS Significant decreases in median nerve area and perimeter as well as significant increases in median nerve strain were observed after carpal tunnel release. The results of this study may be useful when considering how the median nerve recovers after carpal tunnel release.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Japan
| | - Wen-Lin Tung
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Tomoo Ishii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Japan
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43
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Yoshii Y, Tung WL, Ishii T. Measurement of Median Nerve Strain and Applied Pressure for the Diagnosis of Carpal Tunnel Syndrome. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1205-1209. [PMID: 28395966 DOI: 10.1016/j.ultrasmedbio.2017.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 06/07/2023]
Abstract
The objective of this study was to evaluate the diagnostic utility of strain and applied-pressure measurements of the median nerve in carpal tunnel syndrome (CTS). Thirty-five wrists of 23 idiopathic CTS patients and 30 wrists of 15 normal patients were examined. Median nerve strain, pressure to the skin and the pressure/strain ratio were measured at the proximal carpal tunnel level. Parameters were compared between CTS patients and controls. The areas under the receiver operating characteristic curves (AUCs) were compared for the parameters. Median nerve strain was significantly lower in the patients than in the controls (p < 0.01). Pressure and pressure/strain ratio were significantly higher in the patients than in the controls (p < 0.05: pressure, p < 0.01: ratio). The AUCs were 0.926, 0.681 and 0.937 for strain, pressure and pressure/strain ratio, respectively. Pressure/strain ratio is useful for evaluating the condition of the median nerve with respect to the hardness of the surrounding structures in CTS.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Japan.
| | - Wen-Lin Tung
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami, Japan
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Lamouille J, Müller C, Aubry S, Bensamoun S, Raffoul W, Durand S. Extensor indicis proprius tendon transfer using shear wave elastography. HAND SURGERY & REHABILITATION 2017; 36:173-180. [DOI: 10.1016/j.hansur.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/10/2016] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
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Krogh TP, Fredberg U, Ammitzbøl C, Ellingsen T. Ultrasonographic Characteristics of the Common Extensor Tendon of the Elbow in Asymptomatic Individuals: Thickness, Color Doppler Activity, and Bony Spurs. Orthop J Sports Med 2017; 5:2325967117704186. [PMID: 28540316 PMCID: PMC5431425 DOI: 10.1177/2325967117704186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Ultrasonography (US) of the common extensor tendon (CET) of the elbow is often part of the assessment of patients with lateral epicondylitis. This US assessment is currently based on general tendinopathy references and not well-defined US entities. Purpose: To describe CET thickness, color Doppler activity, and bony spurs on US in asymptomatic volunteers and to investigate the influence of sex, age, height, body mass index (BMI), weight, and elbow dominance on the measurements. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Tendon thickness, color Doppler activity, and bony spurs of the CET were measured sonographically in 264 adults (50% women) aged 20 to 96 years. Two different tendon-thickness measuring techniques were applied, labeled the “plateau measure” and the “1-cm measure.” Color Doppler activity was based on a 0 to 4 rating scale (negative, grades 0 and 1; positive, grades 2-4). A bony spur was defined as a bony outgrowth (≥0.3 mm) arising at the insertional site of the CET. Results: With both tendon-thickness measuring techniques, the CET in the dominant elbow was thicker than that in the nondominant elbow, and male tendons were thicker than female tendons (all P ≤ .03). In regression analysis, tendon thickness correlated with weight, color Doppler activity, and arm dominance for both measuring techniques in multiple regression analysis. In addition, the plateau measure correlated with height and the presence of bony spurs. No correlations were observed regarding BMI, sex, or age. Positive color Doppler activity was found in 9% of examined elbows, with no difference between the sexes regarding dominant versus nondominant elbows (all P ≥.20). Bony spurs were found to increase with age, from 23% for people in their 20s to 74% in people older than 70 years. Bony spurs were more common in the dominant elbow (P ≤ .01). Women had a higher prevalence of bony spurs than men, but only in the dominant elbow (P = .03). Conclusion: This study presents the US characteristics and normal values of the CET. In 264 asymptomatic participants, the CET was found to be thicker in men and in the dominant elbow. No difference in tendon thickness could be demonstrated with regard to different age groups. Color Doppler activity was found to be positive in nearly 1 of 10 asymptomatic subjects. Bony spurs were a common finding; they increased in prevalence with every decade in age and were considered part of the aging process. Normal variations in CET morphologic characteristics should therefore be considered when implementing US in trials and clinical practice.
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Affiliation(s)
- Thøger P Krogh
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Torkell Ellingsen
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
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46
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Sonoelastography in the Evaluation of Plantar Fasciitis Treatment: 3-Month Follow-Up After Collagen Injection. Ultrasound Q 2017; 32:327-332. [PMID: 27035685 DOI: 10.1097/ruq.0000000000000233] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether ultrasound elastography can demonstrate the outcome of the treatment in comparison with gray-scale imaging. METHODS Sixteen patients (mean age, 46.9 years) with plantar fasciitis were prospectively enrolled after unsuccessful conservative treatment. Individuals graded their heel pain on a 100-mm visual analogue scale (VAS) and underwent gray-scale ultrasonography and sonoelastography. Collagen was injected in the heels. Fascial thickness and hypoechogenicity, perifascial edema, and plantar fascial elasticity were evaluated. Follow-up sonoelastography and VAS grading were done 3 months after the injection. Statistical analyses were performed by the paired t test and the Fisher exact test. A P < 0.05 was considered statistically significant. RESULTS Mean plantar fascial thickness showed insignificant decrease on follow-up (from 4.30 [1.37] to 4.23 [1.15] mm, P = 0.662). Fascial hypoechogenicity and perifascial edema did not change significantly after treatment. The mean strain ratio of the plantar fascia was significantly increased (from 0.71 [0.24] to 1.66 [0.72], P = 0.001). Softening of the plantar fascia decreased significantly after injection (from 12 to 3 ft, P = 0.004). Twelve (75%) of 16 patients showed significant VAS improvement at the follow-up. CONCLUSIONS Sonoelastography revealed a hardening of the plantar fascia after collagen injection treatment and could aid in monitoring the improvement of the symptoms of plantar fasciitis, in cases where gray-scale imaging is inconclusive.
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47
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Lee KS, Martin J, Thelen D. Science to Practice: Quantitative US Elastography Can Be Used to Quantify Mechanical and Histologic Tendon Healing in a Rabbit Model of Achilles Tendon Transection. Radiology 2017; 283:311-313. [PMID: 28418825 DOI: 10.1148/radiol.2017170126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Compression-based ultrasonographic (US) elastography is associated with time-dependent mechanical and histologic changes of the healing tendon in a transected rabbit model of the Achilles tendon. This finding will lead to continued development of quantitative US, which can be used to objectively assess a diseased or healing tendon. With advances in the method used, clinical translation of tendon elastography may enable clinicians to diagnose tendon damage and track healing, which should improve both treatment and outcome.
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Affiliation(s)
- Kenneth S Lee
- Department of Radiology University of Wisconsin School of Medicine & Public Health 600 Highland Ave Madison, WI 53792
| | - Jack Martin
- Department of Radiology University of Wisconsin School of Medicine & Public Health 600 Highland Ave Madison, WI 53792
| | - Darryl Thelen
- Department of Radiology University of Wisconsin School of Medicine & Public Health 600 Highland Ave Madison, WI 53792
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48
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Lima KMME, Costa Júnior JFS, Pereira WCDA, Oliveira LFD. Assessment of the mechanical properties of the muscle-tendon unit by supersonic shear wave imaging elastography: a review. Ultrasonography 2017; 37:3-15. [PMID: 28607322 PMCID: PMC5769952 DOI: 10.14366/usg.17017] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/15/2017] [Accepted: 04/15/2017] [Indexed: 12/25/2022] Open
Abstract
This review aimed to describe the state of the art in muscle-tendon unit (MTU) assessment by supersonic shear wave imaging (SSI) elastography in states of muscle contraction and stretching, during aging, and in response to injury and therapeutic interventions. A consensus exists that MTU elasticity increases during passive stretching or contraction, and decreases after static stretching, electrostimulation, massage, and dry needling. There is currently no agreement regarding changes in the MTU due to aging and injury. Currently, the application of SSI for the purpose of diagnosis, rehabilitation, and physical training remains limited by a number of issues, including the lack of normative value ranges, the lack of consensus regarding the appropriate terminology, and an inadequate understanding of the main technical limitations of this novel technology.
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Affiliation(s)
- Kelly Mônica Marinho E Lima
- Laboratory of Biomechanics of the Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Liliam Fernandes de Oliveira
- Laboratory of Biomechanics of the Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Basra HAS, Humphries PD. Juvenile idiopathic arthritis: what is the utility of ultrasound? Br J Radiol 2017; 90:20160920. [PMID: 28291375 DOI: 10.1259/bjr.20160920] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a heterogeneous condition and an important cause of acquired disability in children. Evidence supports early treatment to prevent future complications. This relies on prompt diagnosis, achieved by a high index of clinical suspicion and supportive evidence, including the detection of joint and or tendon inflammation. Ultrasound is a readily accessible, well-tolerated, safe and accurate modality for assessing joints and the surrounding soft tissues. It can also be used to guide therapy into those joints and tendon sheaths resistant to systemic treatments. Ultrasound imaging is highly operator dependent, and the developing skeleton poses unique challenges in interpretation with sonographic findings that can mimic pathology and vice versa. Ultrasound technology has been rapidly improving and is more accessible than ever before. In this article, we review the normal appearances, highlight potential pitfalls and present the key pathological findings commonly seen in JIA.
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Affiliation(s)
- Hershernpal A S Basra
- 1 Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Paul D Humphries
- 2 Department of Radiology, Great Ormond Street Hospital for Children, University College London Hospital NHS Foundation Trust, London, UK
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50
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Ahn KS, Lee NJ, Kang CH, Lee YH, Jeon HJ. Serial Changes of Tendon Histomorphology and Strain Elastography After Induced Achilles Tendinopathy in Rabbits: An In Vivo Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:767-774. [PMID: 28150323 DOI: 10.7863/ultra.16.02059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 06/27/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate and compare the serial changes of morphology and strain in the early process of Achilles tendinopathy in a rabbit model. METHODS A total of 10 New Zealand white rabbits underwent ligation of one of their Achilles tendons to induce ischemic injury. Both inflamed and contralateral Achilles tendons were serially evaluated with 3 follow-ups: the first on days 3 to 5, the second on days 9 to 13, and the third and last follow-up on days 15 to 20 after surgery. During each examination, tendon thickness was measured and red, green, and blue pixel intensities of the elastogram were analyzed using color histogram analysis software. Differences between the inflamed and control group were compared. RESULTS The mean thickness of the inflamed tendons increased during consecutive follow-ups and was significantly larger than that of control tendons (P < .01). The mean red pixel intensity ratio of the inflamed tendons was also serially increased and was higher than that in the control tendons, indicating softening. However, the difference was significant only in the second and third follow-ups (P < .01). CONCLUSIONS Tendon thickening and softening developed during the early process of Achilles tendinopathy in a rabbit model. Tendon softening may present later than thickening.
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Affiliation(s)
- Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Nam Joon Lee
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
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