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Anatomy of quadriceps femoris muscle group, which includes rectus femoris, vastus lateralis, vastus medialis and vastus intermedius. (Generated using the BioDigital Human Platform, BioDigital Systems, New York City, USA).
Source publication
Elderly people often suffer from sarcopenia in their lower extremities, which gives rise to the increased susceptibility of fall. Comparing the mechanical properties of the knee extensor/flexors on elderly and young subjects is helpful in understanding the underlying mechanisms of the muscle aging process. However, although the stiffness of skeleta...
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Background:
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Methods:
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Objective:
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Methods:
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Citations
... Assessing muscle stiffness using SWE can reflect the structure and composition of muscles 29 . Various studies have found stiffness to increase during muscle contraction compared to the relaxed state, and SWE has shown reliable repeatability when environmental factors, such as contraction or relaxation and measurement depth, are appropriately standardized 20,30,31 . Regarding paraspinal muscles, stiffness was measured reliably in the rest position 32 . ...
Scoliosis is a three-dimensional spinal deformity, and paraspinal muscles play an important role as stabilizers of the spinal curve. In this prospective study, we compared elasticity changes in the paraspinal muscles of adolescent patients with scoliosis after surgery or bracing. Elasticity was measured on the concave and convex sides of the paraspinal muscles at the apex of the curve at the beginning of treatment and 6 and 12 months after treatment. Twenty-six patients with correction surgery (n = 15) or bracing (n = 11) were included. At initial evaluation, the Cobb angle was larger in the surgery group (72.3 ± 20.2° in surgery vs. 30.6 ± 5.1° in brace, p < 0.001). The estimated mean elasticity value of the paraspinal muscles was lower in the surgery group at baseline on the convex side (15.8 vs. 22.8 kPa, p = 0.037) and 6 months on both the concave (12.1 vs. 22.7 kPa, p = 0.004) and convex (13.4 vs. 23.8 kPa, p = 0.005) sides. There was a significant stiffness decrease from baseline to 6 months on the concave side in the surgery group (5.9 kPa, p = 0.025). However, the elasticity change recovered at 12 months without significant differences between the two groups.
... Experimental studies have determined physiological elasticity values of lower limb muscles, such as the gastrocnemius muscle [16]. Explorative studies have depicted significant differences in the muscle elasticity in a relaxed and contracted state [16,17]. Our recent study [18] obtained median and cutoff values for muscle elasticity during the active exercise of the medial gastrocnemius muscle of healthy participants and chronic heart failure patients. ...
Background and objectives
Limb ischemia or compartment syndrome, requiring surgery, are some of the frequent cannula-related complications in patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The purpose of this exploratory study is to depict and evaluate the dynamic changes in the lower limb muscles with ultrasound shear wave elastography as marker for early lower limb ischemia.
Methods
Eleven patients with VA-ECMO after cardiac arrest were included in this study. Seven patients received distal perfusion cannula (DPC) after implantation of the VA-ECMO, whereas 4 had no DPC after VA-ECMO. Compartment syndrome was clinically excluded in all patients. Both lower limbs, e.g., with and without arterial cannula, were monitored with near-infrared spectroscopy (NIRS) for the oxygen saturation of the local tissue. We performed ultrasound shear wave elastrography (SWE) to assess dynamic changes of the medial gastrocnemius muscle at maximum passive muscle stretch (exercise) of both legs. Color-coded duplexsonography was conducted to examine the blood flow velocity of the popliteal artery of the lower limb.
Results
We found no difference between DPC and no DPC ( p = 0.115) during use of VA-ECMO. However, we detected marked lower limb muscle perfusion deficits of cannulated (58.9 ± 13.5 kPa) vs. cannula-free limb (95.7 ± 27.9 kPa: p < 0.001), applying SWE. No relationship was detected between NIRS measurements and SWE values (kPa) of both lower limbs. The mean peak systolic velocity of the popliteal artery at the cannulated side (30.0 ± 11.7 cm/s) was reduced compared to the non-cannulated side (39.3 ± 18.6 cm/s; p = 0.054).
Conclusions
Regardless of DPC after implantation of VA-ECMO, the gastrocnemius muscles seem to lose function due to cannula-related microcirculatory deficits. Muscle function analysis via SWE combined with NIRS might offer a sensitive indicator for early onset leg ischemia during VA-ECMO-related arterial cannulation.
... Muscle thickness, echo intensity, and shear modulus are used as indices of muscle quantity, quality, and mechanical properties, respectively (Fukumoto et al., 2015;Wang et al., 2014). B-mode ultrasound can be used to noninvasively evaluate muscle thickness and echo intensity. ...
Purpose
This study aimed to clarify age‐related changes in the iliocapsularis (IC) using indicators of quantity, quality, and mechanical properties. We also compared the age‐related changes in the IC and other hip muscles.
Methods
Eighty‐seven healthy women (ages: 21‐82 years, mean age: 45.9±15.7 years) participated in the experiment. We measured thickness, echo intensity, and shear modulus of the IC, iliacus muscle, rectus femoris, and the thickness and shear modulus of the hip joint capsule. Spearman's rank correlation coefficient was used to measure the association of age with variables measured in the muscles and joint capsule.
Results
Thickness of the iliacus muscle and rectus femoris decreased significantly with age, but the thickness of the IC and hip joint capsule showed no significant correlation. The echo intensities of the IC, iliacus muscle, and rectus femoris were positively correlated, which increased with age. Furthermore, the shear modulus of the iliacus, rectus femoris, and hip joint capsule showed an increase with age, whereas the shear modulus of the IC exhibited no correlation with age.
Conclusion
The muscle quality of the IC changed significantly , unlike that of the iliacus or rectus femoris . Additionally, the correlation with echo intensity was relatively weaker in the IC compared with the iliacus or rectus femoris.
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... Strain elastography specifically suffers from the eggshell effect where harder tissues at the boundary of tissues can be difficult to deform, thus limiting the analyzation of internal strain [116]. Some studies also suggest that elastography is dependent on the studied muscle's pennation angle [117]. When compared with traditional material testing techniques, SWE correlates well when the transducer is parallel to the underlying muscle fibers, highlighting that standardization of elastography protocols is important [83,118,119]. ...
Ultrasound (US) is an important imaging tool for skeletal muscle analysis. The advantages of US include point-of-care access, real-time imaging, cost-effectiveness, and absence of ionizing radiation. However, US can be highly dependent on the operator and/or US system, and a portion of the potentially useful information carried by raw sonographic data is discarded in image formation for routine qualitative US. Quantitative ultrasound (QUS) methods provide analysis of the raw or post-processed data, revealing additional information about normal tissue structure and disease status. There are four QUS categories that can be used on muscle and are important to review. First, quantitative data derived from B-mode images can help determine the macrostructural anatomy and microstructural morphology of muscle tissues. Second, US elastography can provide information about muscle elasticity or stiffness through strain elastography or shear wave elastography (SWE). Strain elastography measures the induced tissue strain caused either by internal or external compression by tracking tissue displacement with detectable speckle in B-mode images of the examined tissue. SWE measures the speed of induced shear waves traveling through the tissue to estimate the tissue elasticity. These shear waves may be produced using external mechanical vibrations or internal “push pulse” ultrasound stimuli. Third, raw radiofrequency signal analyses provide estimates of fundamental tissue parameters, such as the speed of sound, attenuation coefficient, and backscatter coefficient, which correspond to information about muscle tissue microstructure and composition. Lastly, envelope statistical analyses apply various probability distributions to estimate the number density of scatterers and quantify coherent to incoherent signals, thus providing information about microstructural properties of muscle tissue. This review will examine these QUS techniques, published results on QUS evaluation of skeletal muscles, and the strengths and limitations of QUS in skeletal muscle analysis.
... The total amount of force generated can be reduced because of structural changes in the skeletal muscles with aging [36]. According to a previous study, muscle contraction level and stiffness were positively correlated [46], which may indicate a relationship between stiffness and force generation. Our results also support that the force created by contraction is related to absolute stiffness. ...
... In addition, Lee et al. found a moderate to good correlation between these two instruments in the lower limb muscles at rest and during contraction [27]; however, to the best of our knowledge, no studies have been conducted in older populations. In the present study, the relationship was stronger in young adults than in older adults in the MG and TA at rest and under contraction, which is evident from the contractility of muscle fibers, the muscle mass, and the total amount that force generation decreases with aging due to structural changes in the skeletal muscles [44,46]. However, during contraction in older adults, the correlation between the two instruments was significant for the MG but not significant for the TA muscle. ...
The current study investigated the differences in muscle stiffness between older and young adults at rest and during contraction. We also evaluated the differences in muscle stiffness assessments using a myotonometer (MyotonPRO) and shear wave elastography (SWE). Twenty-two older adults (mean age, 66.6 ± 1.6 years) and 23 young adults (mean age, 66.6 ± 1.6 years) participated in this study. Muscle stiffness of the tibialis anterior (TA) and medial gastrocnemius (MG) muscles at rest and during contraction were measured using SWE and the MyotonPRO. The stiffness increase rate (SIR) was also calculated to determine the absolute stiffness difference. The mean muscle stiffness of the TA and MG muscles was significantly lower in older adults than in young adults at rest and during contraction (p < 0.05). Similarly, the SIR values of the TA and MG were significantly lower in older adults than in young adults (p < 0.05). Our results indicate that both instruments could be used to quantify muscle stiffness changes and serve as a cornerstone for assessing aging-related losses in muscle function. Stiffness measures may help exercise professionals to develop an in-depth understanding of muscle impairment at the tissue level.
... However, significant differences in stiffness based on sex were not observed in thigh muscles studied. Wang et al. (15) also investigated differences in shear stiffness of skeletal muscles based on sex and showed similar results. However, Eby et al. (12) reported higher stiffness values for females than males, passive joint torque, and many other parameters, such as muscle cross-sectional area, are also associated with muscle shear stiffness, and differences in joint torque might be less significant compared with other parameters. ...
... In contrast, Eby et al.(12) also investigated the effects of aging on the shear stiffness of the biceps brachii muscle and reported a positive correlation between shear stiffness and age. Furthermore, Wang et al.(15) studied the effects of age on shear stiffness in the vastus intermedius muscle and reported no significant difference based on age, because the age effects on shear stiffness were inconsistent among studies and the present study results might have been affected by the small sample size and exclusion of older subjects, further investigation is needed. ...
Purpose This study aimed to apply MR elastography (MRE) to achieve in vivo evaluation of the
elastic properties of thigh muscles and validate the feasibility of quantifying the elasticity of
normal thigh muscles using MRE.
Materials and Methods This prospective study included 10 volunteer subjects [mean age, 32.5
years, (range, 23–45 years)] who reported normal activities of daily living and underwent both
T2-weighted axial images and MRE of thigh muscles on the same day. A sequence with a motion-
encoding gradient was used in the MRE to map the propagating shear waves in the muscle.
Elastic properties were quantified as the shear modulus of the following four thigh muscles
at rest; the vastus medialis, vastus lateralis, adductor magnus, and biceps femoris.
Results The mean shear modulus was 0.98 ± 0.32 kPa and 1.00 ± 0.33 kPa for the vastus medialis,
1.10 ± 0.46 kPa and 1.07 ± 0.43 kPa for the vastus lateralis, 0.91 ± 0.41 kPa and 0.93 ±
0.47 kPa for the adductor magnus, and 0.99 ± 0.37 kPa and 0.94 ± 0.32 kPa for the biceps femoris,
with reader 1 and 2, respectively. No significant difference was observed in the shear modulus
based on sex (p < 0.05). Aging consistently showed a statistically significant negative correlation
(p < 0.05) with the shear modulus of the thigh muscles, except for the vastus medialis (p =
0.194 for reader 1 and p = 0.355 for reader 2).
Conclusion MRE is a quantitative technique used to measure the elastic properties of individual
muscles with excellent inter-observer agreement. Age was consistently significantly negatively
correlated with the shear stiffness of muscles, except for the vastus medialis.
... However, contrary results have been reported as well. For example, lower muscle stiffness was observed in the four heads of quadriceps muscle [17,18], and comparable level of stiffness in several leg muscles has been reported in aged participants [19][20][21][22]. According to a previous study [16], age-related modulation in muscle stiffness was often influenced by muscle length, which was dependent on joint angles in vivo. ...
Background
In aging, muscle stiffness is considered as one of the factors associated with the reduction of force generation capability. There have been inconsistent findings on age-related alteration in the passive stiffness of quadriceps muscle in the female adults. Thus, the aim of this study was to determine the effect of aging on the shear moduli of the superficial muscle heads of the quadriceps and to explore its relationship with knee extension force.
Methods
Passive shear moduli of the rectus femoris (RF), vastus lateralis (VL), and vastus medialis (VM) were measured at rest using shear wave elastography in 20 young and 20 senior female adults. Measurements were repeated at four knee joint positions, that is, 30°, 60°, 90°, and 105° of knee flexion. Maximal isometric voluntary knee extension force was assessed at 30°, 60°, and 90° of knee flexion.
Results
As per our findings, senior adults were determined to have significantly higher passive muscle shear moduli in the RF (by 34% – 68%; all p < 0.05) and the VL muscle heads (by 13%–16%, all p < 0.05) at and beyond 60° of knee flexion. Age-related increase in the VM was evident at 105° knee flexion (by11%, p = 0.020). The RF shear modulus was negatively correlated to the maximal isometric voluntary contraction force measured at 60° ( r = − 0.485, p = 0.030) in senior adults.
Conclusions
Senior female adults had greater passive stiffness at the superficial muscle heads of the quadriceps muscles when measured at long muscle length. Among the senior female adults, the passive stiffness of RF has been determined to have a negative association with the knee extensor force only at 60° knee flexion. No significant association was noted for other angles and muscles.
... However, currently, the stiffness of in vivo human muscles can be noninvasively quantified as the shear modulus (expressed in the unit of Pascal) using ultrasound shear wave elastography (SWE). Several human studies have used this technique to investigate the effect of age on muscle stiffness and reported decreases [10,11], no changes [10,12], and increases [13] in stiffness in elderly adults compared with young adults. Note that in these studies reporting decreases or no changes in muscle stiffness in elderly adults, muscle stiffness was assessed in positions in which the muscles were relatively short (i.e., less stretched), such as a lying (fully knee extended) position for the quadriceps femoris and a plantarflexed position for the triceps surae. ...
Skeletal muscle fibrosis occurs with aging and has been suggested to impair muscle performance, thereby decreasing quality of life. Recently, muscle stiffness, a surrogate measure of muscle fibrosis, was noninvasively quantified as the shear modulus using ultrasound shear wave elastography (SWE) in humans. We aimed to investigate thigh muscle stiffness in females and males, respectively, across a broad range of ages by using SWE. Eighty-six community-dwelling Japanese people who were aged 30 to 79 years and did not regularly exercise participated in this study. The vastus lateralis (VL) shear modulus was measured at three different knee joint angles: full extension, 90° of flexion, and full flexion. There were no significant main effects of sex or age on the VL shear modulus in full extension or 90° of flexion of the knee. However, the VL shear modulus in knee full flexion was significantly smaller in females than in males and increased with age from 47.9 years. The results suggest that the accelerated increase in VL stiffness that occurs after an individual passes their late 40s may be an important therapeutic target for developing effective treatments and programs that preserve and improve quality of life.
... One study demonstrated an increase in the Young modulus in the muscles of the lower extremity in one individual during muscle contraction (31) . An additional study showed that SW velocities were higher in the contracted vastus intermedius muscles than those that were relaxed (32) . Another study reported increased stiffness of the Achilles tendon with stretching (29) . ...
... Similarly to other investigators (29,31,32) , we have demonstrated expected increased SW velocities and tissue stiffness in the ATFL and CFL with applied stress in young healthy males. ...
Aim of study:
Most sprained lateral ankle ligaments heal uneventfully, but in some cases the ligament's elastic function is not restored, leading to chronic ankle instability. Ultrasound shear wave elastography can be used to quantify the elasticity of musculoskeletal soft tissues; it may serve as a test of ankle ligament function during healing to potentially help differentiate normal from ineffective healing. The purpose of this study was to determine baseline shear wave velocity values for the lateral ankle ligaments in healthy male subjects, and to assess inter-observer reliability.
Material and methods:
Forty-six ankles in 23 healthy male subjects aged 20-40 years underwent shear wave elastography of the lateral ankle ligaments performed by two musculoskeletal radiologists. Each ligament was evaluated three times with the ankle relaxed by both examiners, and under stress by a single examiner. Mean shear wave velocity values were compared for each ligament by each examiner. Inter-observer agreement was evaluated.
Results:
The mean shear wave velocity at rest for the anterior talofibular ligament was 2.09 ± 0.3 (range 1.41-3.17); and for the calcaneofibular ligament 1.99 ± 0.36 (range 1.29-2.88). Good inter-observer agreement was found for the anterior talofibular ligament and calcaneofibular ligament shear wave velocity measurements with the ankle in resting position. There was a significant difference in mean shear wave velocities between rest and stressed conditions for both anterior talofibular ligament (2.09 m/s vs 3.21 m/s; p <0.001) and calcaneofibular ligament (1.99 m/s vs 3.42 m/s; p <0.0001).
Conclusion:
Shear wave elastography shows promise as a reproducible method to quantify ankle ligament stiffness. This study reveals that shear waves velocities of the normal lateral ankle ligaments increased with applied stress compared to the resting state.
... This is in disagreement with other SWE studies, which find either higher shear modulus (Eby et al., 2015) or lower shear modulus or shear wave velocity (Akagi et al., 2015;Alfuraih et al., 2019) in older adults. Two studies that used alternative methods, vibro-ultrasound (Wang et al., 2014) or magnetic resonance elastography (Domire et al., 2009), to measure shear modulus in vivo found similar results to ours, with no difference in vastus intermedius or tibialis anterior shear modulus between younger and older participants. ...
Ageing is associated with alterations in the structure and function of the contractile and elastic tissues that enable movement, posture, and balance. Alterations in structure and mechanical properties of the ankle plantarflexors and Achilles tendon are of particular interest due to their important ‘catapult-like’ function during efficient and healthy human locomotion. In this study, we examined age-related differences in the in vivo mechanical properties of both muscle and tendon in the human ankle plantarflexors in healthy younger (21 ± 3.25 years) and older (69 ± 2.86 years) adults. All participants were physically active, to represent healthy ageing. B-mode ultrasound coupled with force measurements was used to determine in vivo Achilles tendon stiffness and shear-wave elastography was used to measure shear modulus, an index of muscle stiffness, in the medial and lateral gastrocnemii. We found that older adults displayed 43% lower (p = 0.004) Achilles tendon stiffness, 59% lower (p < 0.001) Achilles tendon Young’s modulus, and 34% greater (p = 0.002) Achilles tendon cross-sectional area compared to younger participants. We found no difference in the shear modulus of the medial or lateral gastrocnemii between the younger and older individuals. The reduction in Achilles tendon stiffness coupled with similar gastrocnemii muscle shear modulus likely influences the integrated neuromechanical function of the ankle plantarflexor muscle–tendon units during locomotor tasks. Further investigations into the relationship between altered mechanical properties and in vivo muscle–tendon dynamics will provide greater insights into the age-related declines in mobility and locomotor function.
