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Original articles  DIAGNOSTIC TESTING

The Journal of Sports Medicine and Physical Fitness 2002 March;42(1):120-5

language: English

Ultrasound changes to intramuscular architecture of the quadriceps following intramedullary nailing

leakney R., Maffulli N. *

From the Department of Radiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
*Department of Trauma and Orthopaedic Surgery School of Postgraduate Medicine North Staffordshire Hospital Thornburrow Drive, Hartshill, Stoke on Trent, UK


Background. Disuse atro­phy is the ­basis for pro­found phys­io­log­i­cal chang­es of the mus­cles of immob­il­ised ­limbs. The aim of ­this ­study was to use ­high res­o­lu­tion ­real-­time ultra­so­nog­ra­phy (­HRRTU) to ­assess the quad­ri­ceps mus­cu­la­ture and to try and meas­ure atro­phy.
Methods. We mon­i­tored the ­effects of ­enforced reduc­tion of mobil­ity due to trau­ma on the intra­mus­cu­lar archi­tec­ture of the quad­ri­ceps ­using ­HRRTU in 13 skel­e­tal­ly ­mature ­male ­patients (43.2 ­years, ­range 16 to 82 ­years), ­with an iso­lat­ed uni­lat­er­al dia­phy­seal frac­ture of the ­femur or of the tib­ia. All ­patients had under­gone inter­locked intra­me­dul­lary nail­ing (IIN). Using ­HRRTU, the pen­na­tion ­angles and mus­cle ­fibre ­lengths of vas­tus lat­er­al­is, the ­cross sec­tion­al ­area (CSA) of the rec­tus fem­or­is, and the quad­ri­ceps mus­cle ­layer thick­ness (MLT) ­were meas­ured in the ­injured and the nor­mal con­tra­lat­er­al ­limb.
Results. Repeated meas­ure­ments ­showed the tech­nique of meas­ure­ment of the var­i­ables ­used in ­this ­study to be high­ly repro­du­cible. There was a sig­nif­i­cant dif­fer­ence in the ­angle of pen­na­tion of the vas­tus lat­er­al­is in the ­nailed (15.4°) and the ­unnailed ­limb (21.2°), doc­u­ment­ing ­that mus­cle atro­phy caus­es a ­change to mus­cle archi­tec­ture ­that ­results in a sig­nif­i­cant ­decrease in pen­na­tion ­angle (p=0.0002). The mus­cle ­fibre ­length was sig­nif­i­cant­ly dif­fer­ent (p=0.002) and ­there was a sig­nif­i­cant cor­re­la­tion ­between pen­na­tion ­angle and mus­cle ­fibre ­length (r=-0.51, p=0.001). There was ­also a sig­nif­i­cant dif­fer­ence in the quad­ri­ceps MLT (p=0.001) and CSA of the rec­tus fem­or­is (p=0.0004) imply­ing ­that the ­whole of the quad­ri­ceps mus­cle is affect­ed.
Conclusions. These sim­ple, repro­du­cible, non-inva­sive ultra­sound meas­ure­ments can eas­i­ly dem­on­strate dif­fer­enc­es in the quad­ri­ceps mor­phol­o­gy in the ­nailed and unnail­ed ­limb, ­which ­could ­allow indi­vid­u­al exer­cise pro­gramme pre­scrip­tion.

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