Functional Musculoskeletal Ultrasound
Abstract
Abstract
Although the muscular component in various medical conditions is frequent, its impact is often difficult to confirm. The background of this article concerns the need for tools to qualitatively and quantitatively describe musculoskeletal tissue dynamics and co-ordination during realtime procedures. Tissue velocity ultrasound offers such possibilities. An ultrasound system equipped with tissue velocity imaging (TVI) was used. Registrations were analysed post-process by a research software package. TVI offers four modes to describe tissue activities: tissue velocity, displacement, strain and strain rate. Electromyography (EMG) was used to identify muscle rest and activity. These parameters described different aspects of tissue dynamics. The main finding is that TVI has the sensitivity to visualise and quantify musculoskeletal tissue activity and dynamics. Discrimination between active and passive tissue segments is possible. Both intra- and inter-muscular co-ordination patterns are identified and described. A good correlation is found between tissue activity and EMG activity. TVI is a sensitive method to describe muscle tissue dynamics as a function of muscle performance in realtime. It is possible to scrutinise both intra-muscular and inter-muscular co-ordination patterns.
Keywords Ultrasound, musculoskeletal, tissue velocity imaging (TVI), tissue Doppler imaging (TDI), strain rate, intra-muscular co-ordination, inter-muscular co-ordination
Disclosure: The authors have no conflicts of interest to declare.
Received: 15 September 2009 Accepted: 24 September 2009
Correspondence: Michael Peolsson, Hälsans Nya verktyg, Platensgatan 29, Box 1224, SE-581 12 Linköping, Sweden. E: Mikael.Peolsson@sth.kth.se
The muscular component in various medical conditions is often difficult to diagnose. Electromyography (EMG) is probably the most widely used tool to study muscle function and for a long time has contributed considerable information in various ways. However, so far few methods allow investigation of musculoskeletal dynamics. Tissue velocity imaging (TVI) or the similar tissue Doppler imaging (TDI) is a relatively new ultrasound (US)-based method that wasoriginally developed to study tissue dynamics in the heart muscle.1,2 The image resolution of US systems has improved tremendouslyover the last few years. Both comparatively cheap computing power for image processing and the proliferating plethora of imaging techniques are rapidly adding new qualitative improvements and quantitative possibilities, not only of anatomical landmarks and demarcation but also of functional parameters.
TVI is an umbrella concept that describes different aspects of muscle tissue dynamics. Grubb et al.3 pioneered the musculoskeletal application field of TVI to identify phases in maximal voluntary contractions and to separate active from passive movements. Pulkowski et al.4 used TVI in order to identify the onset of muscle activation according to isokinetic and isometric knee extensions and reported good validity and reliability against EMG. Mannion et al.5 used the same technique and successfully identified the onset of abdominal muscle feed-forward activity. Peolsson et al.6 used TVI to investigate trapezius muscle dynamics after pain provocation among trapezius myalgia patients and non-pain controls. The results suggested a less dynamic trapezius muscle among most trapezius myalgia patients after pain provocation compared with healthy controls.
- Brodin LA, Clin Physiol Funct Imaging, 2004; 24(3):147–55.
- Sutherland GR, et al., J Am Soc Echocardiogr, 2004;17(7):788–802.
- Grubb NR, et al., Radiology, 1995;194(3):837–42.
- Pulkovski N, et al., Muscle Nerve, 2008;37:638–49.
- Mannion AF, et al., J Appl Physiol, 2008;104(4): 1192–1201.
- Peolsson M, et al., BMC Musculoskel Disord, 2008;9:127–41.
- Stoylen A, Strain rate imaging of the left ventricle by ultrasound. Feasibility, clinical validation and physiological aspects, Trondheim: NTNU, Norwegian University of Science and Technology, 2001.
- Heimdal A, et al., J Am Soc Echocardiogr, 1998;11:1013–19.
- D’Hooge J, et al., IEEE Trans Med Imaging, 2002;21(9):1022–30.
- Fukunaga T, et al., J Appl Physiol, 1997;82(1):354–8.
- D’Hooge J, et al., Eur J Echocardiogr, 2000;1(3):154–70.
