Value of shear wave ultrasound elastography in the myofascial pain syndrome diagnosis in sportsmen Poster No.: C-1202 Congress: ECR 2014 Type: Authors: Keywords: DOI: Scientific Exhibit V. Saltykova; Moscow/RU Trauma, Pathology, Diagnostic procedure, Ultrasound, Elastography, Musculoskeletal system, Musculoskeletal soft tissue 10.1594/ecr2014/C-1202 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 12
Aims and objectives Myofascial pain syndrome is a chronic condition characterized by tendomuscular pains mainly localized in the muscle attachment sites and having a widely spread irradiation to other parts of the body. A chronic myofascial pain syndrome is gradually developed due to reduced muscle elasticity in the muscle attachment sites. The pain essentially limits sportsmen's functional abilities. Objectives: To assess the diagnostic value of shear wave ultrasound elastography (SWE) in myofascial pain syndrome of different localization. Keywords: High resolution ultrasound (HRUS), Myofascial pain syndrome, Shear Wave Elastography (SWE) Page 2 of 12
Methods and materials 45 professional sportsmen were enrolled in the study. They were divided into 2 groups: the first group included 20 sportsmen with no signs of lower extremities muscle disease (control group), and the second group included 25 sportsmen who experienced pain in the proximal muscles attachment sites of the outer and inner thigh. Informed consent was obtained after the nature of the procedure had been fully explained. The ultrasound examination was performed using the Aixplorer (Supersonic Imagine, France) ultrasound system and linear probe (4-15 MHz). All patients from groups 1 and 2 have passed examination of the inner and outer thigh muscles using grey scale imaging and shear wave elastography and elastometry to evaluate muscle stiffness at sites of their attachment to the bones. The data obtained was analyzed using the mean value of Young's module (Emean) and standard deviation (SD), E-min, E-max. Page 3 of 12
Results In the 1-st group the elasticity of thigh muscles at their bone attachment site (Me) was as follows: the proximal Gluteus muscle: Emean - 9,9 kpa, SD - 1,7 kpa (Tabl.1, Fig.1); Table 1. Parameter ## Min-Max 5-95percentile #-mean 9,9 4,0-24,1 5,0-23,8 E-min 4,5 0,2-17,9 0,2-17,7 E-max 13,5 6,6-37,1 6,7-37,1 SD 1,7 0,7-8,73 0,8-7,3 along the outer surface above the greater trochanter point - Emean - 9.5 kpa, SD - 2.5 kpa (tabl. 2); along the inner thigh surface: Emean - 14.3 kpa, SD - 2.1 kpa. Table 2. Parameter ## Min-Max 5-95 percentile #-mean 9,5 6,8-37,2 8,0-32,5 E-min 8,6 3,9-24,4 5,5-22,2 E-max 28,0 10,1-66,1 10,2-64,4 SD 2,5 0,6-8,6 0,6-8,3 In the 2-nd group the elasticity of thigh muscles at their bone attachment site (Me) was as follows: proximal Gluteus muscle: Emean - 116.4 kpa; SD - 26.3 kpa (tabl. 3, fig. 2); Table 3. Parameter ## Min-Max 5-95 percentile #-mean 116,4 48,4-291,1 50,2-279,7 E-min 87,8 11,2-269,0 11,2-223,4 E-max 171,0 17,3-453,8 17,3-395 SD 26,3 5,2-49,1 11,1-49,1 along the inner thigh surface: Emean - 135. 6 kpa; SD - 26.8 kpa; distal Gluteus muscle and proximal fascia latae: Emean - 87.6 kpa; SD - 9.4 kpa (tabl. 4, fig. 3, 4). Table 4. Page 4 of 12
Parameter ## Min-Max 5-95percentile #-mean 87,6 32,9-234 36,4-218,7 E-min 24,1 7,2-38,7 7,5-36,6 E-max 143 51,5-297,3 53,2-290,6 SD 9,4 6,6-50,7 6,6-45,4 Page 5 of 12
Images for this section: Fig. 1: Group 1. Ultrasound image. Shear Wave Elastography. The proximal muscles Gluteus attachment. SWE. References: Saltykova VG, Central Research Institute of Traumatology and Orthopedics - Moscow/RU Saltykova VG, Central Research Institute of Traumatology and Orthopedics - Moscow/ RU Page 6 of 12
Fig. 2: Group 2. Myofascial pain syndrome, the proximal muscles Gluteus attachment. Ultrasound image, Shear Wave Elastography. References: Saltykova VG, Central Research Institute of Traumatology and Orthopedics - Moscow/RU Saltykova VG, Central Research Institute of Traumatology and Orthopedics - Moscow/ RU Page 7 of 12
Fig. 3: Group 2. Myofascial pain syndrome, the proximal muscles attachment sites of the outer thigh, the distal muscles Gluteus attachment. Ultrasound image, Shear Wave Elastography. References: Saltykova VG, Central Research Institute of Traumatology and Orthopedics - Moscow/RU Saltykova VG, Central Research Institute of Traumatology and Orthopedics - Moscow/ RU Page 8 of 12
Fig. 4: Group 2. Myofascial pain syndrome, the proximal muscles attachment sites of the outer thigh, Fascia latae. Ultrasound image, Shear Wave Elastography. References: Saltykova VG, Central Research Institute of Traumatology and Orthopedics - Moscow/ RU Saltykova VG, Central Research Institute of Traumatology and Orthopedics - Moscow/ RU Page 9 of 12
Conclusion Shear wave ultrasound elastography gives the possibility to obtain muscle degeneration information using not only grey scale imaging of the muscles but also the quantitative assessment of the muscle elasticity changes. In sportsmen, who develop the myofascial pain syndrome, SWE data may be the helpful indicator for disease course monitoring. Page 10 of 12
Personal information Saltykova Victoria, MD, PhD, Central Research Institute of Traumatology and Orthopedics named after N.N. Priorov of the Ministry of Health of the Russian Federation, Russian Medical Academy of Postgraduate Education of Ministry of Health of the Russian Federation, Moscow email: doctor.saltykova@gmail.com Page 11 of 12
References 1. Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging 1991; 13: 111-134. 2. Botar-Jid C, Vasilescu D, Dudea SM, Damian L, Badea R. Ultrasound elastography in musculoskeletal disorders. Ultraschall in Med, 2008, suppl 1, OP9.9. http://www.hitachimedical-systems.eu/fileadmin/hitachi_en/ downloads/ hi-rte-publications-and-communications-clinical-abstracts--- musculoskeletal-applications-11-06-10.pdf. 3. Lalitha P, Reddy MCh, Reddy KJ. Musculoskeletal applications of elastography: a pictorial essay of our initial experience. Korean J Radiol 2011;12:365-375. 4. Monetti G, Minafra P. The Musculoskeletal Elastography; MEDIX Suppl 2007:43-45. 5. Shinohara M., Sabra K., Gennisson J.-L., Fink M., Tanter M.L., Realtime visualization of muscle stiffness distribution with ultrasound Shear Wave imaging during muscle contraction. Muscle Nerve. 2010. Vol. 42. P. 438-441. Page 12 of 12