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Ultrasound examination is a broadly available method that can also be used in diagnosing locomotor system disorders. Elastography is one of the more recent ultrasound techniques that is currently most utilized in diagnosing pathologies of the liver, thyroid gland, breast, and prostate. Over the past several years, numerous studies have emerged in which the authors measured the elasticity of the locomotor system tissues. Both functional and structural disorders of the locomotor system are known to often cause changes in tissue stiffness that can vary depending on the current state. These changes could previously be detected only by palpation, which, opposed to elastography, did not provide objective data. There is still a lack of guidelines defining the methodol-ogy of examining particular structures in the locomotor system. Ultrasound elastography could contribute to better understanding of the function of the locomotor system, diagnosis of its pathologies, or the assessment of therapy efficacy, for example in rehabilitation. © 2020, Czech Medical Association J.E. Purkyne. All rights reserved.

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PurposePassive muscle stiffness and muscle architecture at a given joint angle, as well as slack angle of the muscle have been shown to change after an acute bout of stretching. However, it remains unclear whether passive muscle stiffness at a given fascicle length is reduced after stretching. We aimed to elucidate the acute effect of static stretching on the passive fascicle stiffness using ultrasound shear wave elastography. Methods Shear modulus, fascicle length, and slack angle of the medial gastrocnemius (MG) as well as passive plantar flexion torque during passive dorsiflexion were measured before and after a 5-min static stretching in 14 healthy males. ResultsAfter stretching, passive torques were significantly reduced at >50% of range of motion (ROM). Shear modulus at a given fascicle length was significantly reduced at >80% of the change in fascicle length during passive dorsiflexion. Slack angle of MG was observed at the middle part of ROM and significantly shifted toward more dorsiflexed position after stretching. Conclusion The present study showed the significant effectiveness of static stretching on the passive fascicle stiffness. Furthermore, the present results suggest that both the shift in slack angle and the reduction in passive fascicle stiffness contribute to produce the change in passive torque-joint angle relationship during passive dorsiflexion. Notably, the contribution of the reduced passive fascicle stiffness to the decrease in passive torque is substantial over the latter part of ROM.
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Histolopathological studies have demonstrated a generalized increase in extracellular connective tissue in spastic muscles. It is known that increased connective tissue in an immobilized and contracted muscle reduces its compliance and could reduce the threshold for stimulation of spindle receptors in the muscle. Various authors have investigated how increased stretch-induced stimulation of spindles in muscles with stiffer connective tissue can contribute to spasticity. In this review, we compile evidence for the idea that the primary injury to the central nervous system that leads to muscle paresis also triggers changes in the viscosity of the extracellular matrix due to abnormal turnover of hyaluronic acid. Hyaluronic acid is a complex molecule that exhibits non-Newtonian behavior at higher concentrations, leading to altered connective tissue viscosity, which begins a vicious circle that exacerbates spasticity through reduced tissue compliance and potentiation of reflex mechanisms and fibrosis, and contributes to abnormal limb posturing, pain symptoms, and decreases in activities of daily living. The rationale for emerging treatments to break this vicious circle are discussed.
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Myofascial pain syndrome (MPS) is described as the muscle, sensory, motor, and autonomic nervous system symptoms caused by stimulation of myofascial trigger points (MTP). The participation of fascia in this syndrome has often been neglected. Several manual and physical approaches have been proposed to improve myofascial function after traumatic injuries, but the processes that induce pathological modifications of myofascial tissue after trauma remain unclear. Alterations in collagen fiber composition, in fibroblasts or in extracellular matrix composition have been postulated. We summarize here recent developments in the biology of fascia, and in particular, its associated hyaluronan (HA)-rich matrix that address the issue of MPS.
Aim: To examine the influence of hormonal changes during the menstrual cycle on deep fasciae. Methods: A total of 29 women, 17 users and 12 non-users of hormonal contraceptives, were examined clinically and by ultrasound, including shear-wave elastography, at two phases of the menstrual cycle. The thickness and elasticity of the fascia lata, thoracolumbar fascia, and plantar fascia were measured, compared between hormonal contraceptive users and non-users, and correlated with clinical data. Results: There were statistically significant differences between users and non-users of hormonal contraceptives: the thoracolumbar fascia was thicker in non-users (p = 0.011), and non-users had higher maximal and mean stiffnesses of the fascia lata (p = 0.01 and p = 0.0095, respectively). Generally, non-users had a higher body mass index (BMI). The elasticity of the thoracolumbar and the plantar fasciae did not differ significantly between the groups. We found no correlation between thickness and elasticity in the fasciae. There were no statistically significant differences in hypermobility, cephalgia, or dysmenorrhea between users and non-users of hormonal contraceptives. Conclusion: The results of this pilot study suggest that deep fasciae can be evaluated by shear wave elastography. Non-users of contraceptives had greater stiffness of the fascia lata and higher BMI. This article is protected by copyright. All rights reserved.
Entrapment neuropathies are debilitating clinical conditions, creating significant morbidity in the upper and lower extremities in terms of pain, sensory abnormalities, and motor weakness, becoming a challenge to diagnose and treat. Because entrapments can have multiple origins, a misinterpretation of anatomy during examination can lead to incorrect diagnosis and treatment. This review addresses understanding of the anatomy of fascia that can play an important role in this syndrome. There is a specific microenvironment around the nerve composed of connective tissues that include deep fascia, intermuscular septa, epineurium, and perineurium. The microenvironmental modifications can be translated into change in mobility with consequence decreasing of the independency of the nerve from the surrounding structures lading to entrapments and “internal stretch lesion.” The entrapments reported in this article reinforce the importance of fascia tissue in generating common symptoms that pose more difficult diagnostic challenges and may often be confused with more common clinical conditions. Clin. Anat., 2019.
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.
Introduction Myofascial trigger points (MTrPs) are one of the most common and important causes of musculoskeletal pain. An ultrasound is a useful modality in examining musculoskeletal disorders. By applying compressive stress and observing changes in ultrasound images, the elastic modulus (Young’s modulus) can be calculated. Our objective was to develop a novel method to distinguish MTrPs from normal tissues. Methods A total of 29 subjects with MTrP in the sternocleidomastoid muscle were assessed. A force gauge was attached to a transducer to obtain stress levels. To obtain strain, images were recorded in both with stress and without stress states. By dividing the stress level by the measured strain, the elastic modulus was determined. Results Elastic modulus in MTrPs and the normal part of the muscle were measured to be 13379.57±1069.75Pa and 7078.24±482.92Pa, respectively (P=0.001). This indicated that MTrPs were stiffer than normal parts of the muscle. Conclusion This study presented a new method for the quantitative measurement of the elastic modulus of MTrP, thereby distinguishing MTrPs from normal adjacent muscular tissue with more simplicity and lower cost, compared to other ultrasound methods.
Ultrasound is widely used for medical diagnosis and increasingly for therapeutic purposes. An understanding of the bio-effects of sonography is important for clinicians and scientists working in the field because permanent damage to biological tissues can occur at high levels of exposure. Here the underlying principles of thermal mechanisms and the physical interactions of ultrasound with biological tissues are reviewed. Adverse health effects derived from cellular studies, animal studies and clinical reports are reviewed to provide insight into the in vitro and in vivo bio-effects of ultrasound.
Objectives: This study aimed to compare the effects of myofascial release (MFR) and hot pack therapy (HPT) on fascial gliding and flexibility of the vastus lateralis muscle. Methods: Three treatments were applied to the left vastus lateralis muscles of each participant (12 healthy males): MFR for 4 min, superficial HPT for 10 min, and superficial HPT for 20 min. Deep fascial motion was measured by B-mode ultrasound, whereas muscle stiffness was measured by real-time elastography (RTE) and a durometer before and after the interventions. Results: Only MFR resulted in changes in both deep fascial motion and muscle stiffness measured by RTE. Durometer-measured muscle stiffness revealed changes following both MFR and 20-min HPT but not 10-min HPT. Conclusions: HPT may produce only superficial effects. Because MFR improved all measured parameters, continuous stretching and pressure are probably important for improving fascial gliding and flexibility of the vastus lateralis muscle.
Ultrasonography has been widely used for diagnosis since it was first introduced in clinical practice in the 1970's. Since then, new ultrasound modalities have been developed, such as Doppler imaging, which provides new information for diagnosis. Elastography was developed in the 1990's to map tissue stiffness, and reproduces/replaces the palpation performed by clinicians. In this paper, we introduce the principles of elastography and give a technical summary for the main elastography techniques: from quasi-static methods that require a static compression of the tissue to dynamic methods that uses the propagation of mechanical waves in the body. Several dynamic methods are discussed: vibro-acoustography, Acoustic Radiation Force Impulsion (ARFI), transient elastography, shear wave imaging, etc. This paper aims to help the reader at understanding the differences between the different methods of this promising imaging modality that may become a significant tool in medical imaging.
To develop clinical guidelines for musculoskeletal ultrasound (MSKUS) referral in Europe. Sixteen musculoskeletal radiologists from seven European countries participated in a consensus-based interactive process (Delphi method) using consecutive questionnaires and consensus procedure meetings at several European radiology meetings. The evaluation of musculoskeletal diseases was established by literature reviews, followed by consensus on clinical utility in three consensus meetings. This involved a thorough, transparent, iterative approach which including interview, questionnaire, Delphi and standard setting methodologies. European MSK radiologists with a special interest in MSKUS formed two different expert groups who worked on reaching a consensus in the first two meetings. The third meeting resolved questions that did not achieve a consensus level of 67% using the first two questionnaires. On expert consensus, the use of MSKUS is indicated to detect joint synovitis, fluid and septic effusion for potential aspiration, and poorly indicated to detect loose bodies. Recommendations for most appropriate use of musculoskeletal ultrasound are reported in six areas relevant to musculoskeletal ultrasound: hand/wrist, elbow, shoulder, hip, knee and ankle/foot. A comprehensive evidence-based, expert consensus-defined educational framework on clinical ultrsound is presented. This should facilitate referrals for this important imaging technique throughout Europe. KEY POINTS : • Musculoskeletal ultrasound is indicated for detecting joint synovitis, effusions and fluid collections. • Musculoskeletal ultrasound is poor at detecting loose bodies. • Musculoskeletal ultrasound is relevant for most joints.
The purpose of this study was to examine the range and prevalence of asymp tomatic findings at sonography of the shoulder. The study sample comprised 51 consecutively enrolled subjects who had no symptoms in either shoulder. Ultrasound of one shoulder per patient was performed by a musculoskeletal sonographer according to a defined protocol that included imaging of the rotator cuff, tendon of the long head of the biceps brachii muscle, subacromial-subdeltoid bursa, acromioclavicular joint, and posterior labrum. The shoulder imaged was determined at random. The 51 scans were retrospectively analyzed by three fellowship-trained musculoskeletal radiologists in consensus, and pathologic findings were recorded. Subtle or questionable findings of mild tendinosis, bursal prominence, and mild osteoarthritis were not recorded. Twenty-five right and 26 left shoulders were imaged. The subject age range was 40-70 years. Ultrasound showed subacromial-subdeltoid bursal thickening in 78% (40/51) of the subjects, acromioclavicular joint osteoarthritis in 65% (33/51), supraspinatus tendinosis in 39% (20/51), subscapularis tendinosis in 25% (13/51), partial-thickness tear of the bursal side of the supraspinatus tendon in 22% (11/51), and posterior glenoid labral abnormality in 14% (7/51). All other findings had a prevalence of 10% or less. Asymptomatic shoulder abnormalities were found in 96% of the subjects. The most common were subacromial-subdeltoid bursal thickening, acromioclavicular joint osteoarthritis, and supraspinatus tendinosis. Ultrasound findings should be interpreted closely with clinical findings to determine the cause of symptoms.
A stand-alone ultrasound shear wave imaging technology has been developed to quantify and visualize Young's modulus distribution by remotely applying ultrasound radiation force and tracking the resulting microvibrations in soft tissues with ultrafast ultrasound imaging. We report the first preliminary data that detected the distribution of local muscle stiffness within and between resting and contracting muscles at different muscle lengths with this technology. This technique may assist clinicians in characterizing muscle injuries or neuromuscular disorders.
Referred pain, that is, pain perceived in an area other than that in which the noxious stimulation takes place, is very frequent in the clinical setting. There are various forms of referred muscle pain from viscera and from somatic structures. Examples of the latter are referred pain from one muscle to another muscle (as in myofascial pain syndromes) and referred pain from joints (as in osteoarthritis of the knee). Whatever the origin of the symptom, a condition of secondary hyperalgesia very often takes place in the referred zones, together with trophic tissue changes. Referred muscle pain from viscera without hyperalgesia is explained on the basis of the convergence of visceral and somatic afferent fibers on the same central neurons. Referred muscle pain from viscera with hyperalgesia is not completely understood; it is hypothesized that it is due to both central (sensitization process) and peripheral (intervention of reflex arcs) mechanisms. Referred muscle pain from other muscles or from joints is not easily explained by the mechanism of "central convergence" in its original form, because in dorsal horn neurons there is little convergence from deep tissues. It has been proposed that convergent connections from deep tissues to dorsal horn neurons are not present from the beginning but are opened by nociceptive input from skeletal muscle, and referral to myotomes outside the lesion is due to a spread of central sensitization to adjacent spinal segments.
Shear-wave elastography: A new objective method for evaluating scar fibrosis. Wound Rep and Reg
  • H Dejong
  • S Abbott
  • M Zelesco
  • B Kennedy
  • Al
DEJONG, H., ABBOTT, S., ZELESCO, M., KENNEDY, B. ET AL.: Shear-wave elastography: A new objective method for evaluating scar fibrosis. Wound Rep and Reg, 26, 2018, s. 17-35.
Shear wave elastography (SWE) for the evaluation of patients with tendinopathies
  • T Dirrichs
  • V Quack
  • M Gatz
  • M Tingart
  • Al
DIRRICHS, T., QUACK, V., GATZ, M., TINGART, M. ET AL.: Shear wave elastography (SWE) for the evaluation of patients with tendinopathies. Academic Radiology, 2016/10/01/ 2016, 23(10), 1204-1213.
Ultrazvuková elastografie a její využití v oblasti hlavy a krku
  • J Heřman
  • Z Heřmanová
  • R Salzman
  • J Vomáčka
  • Al
HEŘMAN, J., HEŘMANOVÁ, Z., SALZMAN, R., VOMÁČKA, J. ET AL.: Ultrazvuková elastografie a její využití v oblasti hlavy a krku. Časopis lékařů českých, 154, 2015, 5, s. 222-226.
Shear wave elastography safety in fetus: A quantitative health risk assessment
  • M Issaoui
  • A Debost-Legrand
  • K Skerl
  • B Chauveau
  • Al
ISSAOUI, M., DEBOST-LEGRAND, A., SKERL, K., CHAUVEAU, B. ET AL.: Shear wave elastography safety in fetus: A quantitative health risk assessment. Diagn Interv Imaging, 99, 2018, 9, s. 519-524.
Funkční změny hybného systému spojené s bolestivými stavy
  • P Kolář
  • Z Čech
KOLÁŘ, P., ČECH, Z.: Funkční změny hybného systému spojené s bolestivými stavy. In Rokyta et al.: Bolest -monografie algeziologie. Praha: Tigis, 2012.
Ultrasound elastography for carpal tunnel pressure measurement: A cadaveric validation study
  • K Kubo
  • B Zhou
  • Y S Cheng
  • T H Yang
  • Al
KUBO, K., ZHOU, B., CHENG, Y. S., YANG, T. H. ET AL.: Ultrasound elastography for carpal tunnel pressure measurement: A cadaveric validation study. J Orthop Res, 36, 2018, 1, s. 477-483.
Manipulační léčba v myoskeletální medicíně. Praha. Sdělovací technika ve spolupráci s Českou lékařskou společností
  • K Lewit
LEWIT, K.: Manipulační léčba v myoskeletální medicíně. Praha. Sdělovací technika ve spolupráci s Českou lékařskou společností J. E. Purkyně, 2003.
Manual of diagnostic ultrasound. World Health Organization
  • H Lutz
  • E Buscarini
  • World
  • O Health
LUTZ, H., BUSCARINI, E., WORLD HEALTH, O.: Manual of diagnostic ultrasound. World Health Organization, 2011.
Zobrazovací metody využívající neionizující záření
  • M Sedlář
  • E Staffa
  • V Mornstein
SEDLÁŘ, M., STAFFA, E., MORNSTEIN, V.: Zobrazovací metody využívající neionizující záření [online]. [Brno]: Biofyzikální ústav Lékařské fakulty Masarykovy univerzity v Brně, 2014. Dostupné na:
Ultrasound elastography: Review of Techniques and Clinical Applications
  • R M S Sigrist
  • J Liau
  • A E Kaffas
  • M C Chammas
  • Al
SIGRIST, R. M. S., LIAU, J., KAFFAS, A. E., CHAMMAS, M. C. ET AL.: Ultrasound elastography: Review of Techniques and Clinical Applications. Theranostics, 7, 2017, 5, s. 1303-1329.
The fasciacytes: A new cell devoted to fascial gliding regulation
  • C C Stecco
  • V Fede
  • A Macchi
  • Porzionato
  • Al
STECCO, C. C. FEDE, V. MACCHI, A. PORZIONATO ET AL.: The fasciacytes: A new cell devoted to fascial gliding regulation. Clin Anat, 31, 2018, 5, s. 667-676.
Quantitative evaluation of masseter muscle stiffness in patients with temporomandibular disorders using shear wave elastography
  • M Takashima
  • Y Arai
  • A Kawamura
  • T Hayashi
  • Al
TAKASHIMA, M., ARAI, Y., KAWAMURA, A., HAYASHI, T. ET AL.: Quantitative evaluation of masseter muscle stiffness in patients with temporomandibular disorders using shear wave elastography. J Prosthodont Res, 61, 2017, 4, s. 432-438.
Influence of female hormones on fascia elasticity: An elastography study
  • M Vita
  • Z Sedláčkova
  • M Heřman
  • T Furst
  • Al
VITA, M., SEDLÁČKOVA, Z., HEŘMAN, M., FURST, T. ET AL.: Influence of female hormones on fascia elasticity: An elastography study. Clin Anat, 32, 2019, 7, s. 941-947.