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Europa Medicophysica 1999 June;35(2):69-73


lingua: Inglese

Ultrasound monitoring of patients with leg muscle atrophy

Capodaglio P., Ciuffreda L., Susta D., Faccioli M., Notarangelo G., Narici M. V.

Center for the Study of Motor Activities CSAM, “S. Maugeri Foundation” IRCCS, Institute of Pavia, Italy


BACKGROUND: So far, the descrip­tion of mus­cle atro­phy in ­humans has ­been most­ly ­based on chang­es in ana­tom­i­cal ­cross-sec­tion­al ­area (­ACSA) meas­ured at spe­cif­ic ­sites ­along the mus­cle bel­ly by imag­ing tech­niques. However, ­there is experi­men­tal evi­dence of region­al dif­fer­enc­es in mus­cle atro­phy and there­fore chang­es in the inter­nal archi­tec­ture of the mus­cle ­could go unde­tect­ed on the ­basis of ­ACSA cal­cu­la­tions. Skeletal mus­cles can be divid­ed ­into rough­ly two cat­e­go­ries: par­allel mus­cles, ­whose mus­cle ­fibres are par­allel to the ten­don ­attached to the ­bone and are there­fore on the trac­tion ­axis of the mus­cle, and pen­nated mus­cles, ­whose ­fibres are con­nect­ed to the ten­di­nous ­sheet ­with an ­angle ­defined as the “pen­na­tion ­angle”. In a pre­vi­ous ­study, we dem­on­strat­ed ­that mus­cle atro­phy led to a ­decrease in pen­na­tion ­angle and ­fibre ­length. The ­present ­study aimed dem­on­strate ­that to ultra­sound may rep­re­sent a sim­ple, disposable non-inva­sive meth­od to be used in rehabilitation medicine to assess­ mus­cle atro­phy and mon­i­tor­ing chang­es in mus­cle archi­tec­ture ­after rehabilitation.
EMTHODS: Ten ­patients (6 ­males, 4 ­females, 21-41 yrs.) ­with uni­lat­er­al mus­cle atro­phy ­were admit­ted to ­this ­study. Maximum ana­tom­i­cal CSA of the gas­troc­ne­mi­us medi­al­is (GM) was deter­mined ­with CT ­scans of ­both ­legs. GM mus­cle ­fiber pen­na­tion ­angle and ­fiber ­length ­were meas­ured in ­both ­legs in the ­same ­region of max­i­mum CSA by ­real-­time ultra­sound ­with a 7.5 MHz, 4 cm ­long, lin­e­ar ­probe. Maximal vol­un­tary and electri­cal­ly ­evoked ­torque of the plan­tar flex­or mus­cles ­were meas­ured. The ­twitch inter­po­la­tion tech­nique was ­also ­used. The meas­ure­ments ­were repeat­ed ­after a one ­month reha­bil­i­ta­tion period in all of subject.
RESULTS: The ­mean pre-reha­bil­i­ta­tion CSA was 17.8 cm2 in the unaf­fect­ed ­limb and 16.7 cm2 in the affect­ed ­limb; the ­post-reha­bil­i­ta­tion val­ues ­were 19.8 cm2 in the unaf­fect­ed ­limb and 18.2 cm2 in the affect­ed ­limb. Mean pen­na­tion ­angles dif­fered by 11% (25.5% in the unaf­fect­ed ­limb and 22.8% in the affect­ed ­limb, p<0.02) at pre-reha­bil­i­ta­tion, ­while no sig­nif­i­cant dif­fer­enc­es ­were ­observed at ­post-reha­bil­i­ta­tion. No chang­es in ­fiber ­length ­were ­observed at pre- and ­post-reha­bil­i­ta­tion. Affected to unaf­fect­ed dif­fer­enc­es in max­i­mal vol­un­tary ­strength var­ied ­from 32.4% at pre-reha­bil­i­ta­tion to 9.6% at post­re­ha­bil­i­ta­tion.
CONCLUSIONS: This ­study ­showed ­that US pro­vides a sim­ple non-inva­sive ­means of quan­ti­fy­ mus­cle atro­phy and mon­i­tor­ing chang­es fol­low­ing reha­bil­i­ta­tion. Structural chang­es in CSA and pen­na­tion ­angle as mon­i­tored by US, and func­tion­al chang­es in mus­cle max­i­mal ­strength pro­vide an “up to ­date” pro­file of the mus­cu­lar archi­tec­ture and per­for­mance capac­ity. US rep­re­sents a sen­si­tive-to-­change meth­od to evaluate the ­degree of mus­cle atro­phy in reha­bil­i­ta­tion ­patients.

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