Shear wave elastography is a valuable tool for diagnosing and grading carpal tunnel syndrome.

OBJECTIVE: To quantify the shear velocity and stiffness of the median nerve (MN) with shear wave elastography (SWE) at the carpal tunnel entrance and determine whether SWE is useful for diagnosing and staging carpal tunnel syndrome (CTS). MATERIALS AND METHODS: The study included 58 patients (79 wrists) with clinical and electroneuromyographic diagnoses of CTS and 55 healthy controls (63 wrists). MN shear velocity and stiffness were measured by SWE on the axial plane in both groups. The differences between CTS patients and controls and between different grades of CTS based on electrodiagnostic tests were studied using Student's t test and ANOVA with ROC analysis. RESULTS: The mean MN shear velocity and stiffness were significantly greater in CTS patients (2.5 ± 0.37 m/s and 19.4 ± 5.8 kPa) than in controls (1.91 ± 0.24 m/s and 11.1 ± 3.0 kPa) (p < 0.001) and greater in the severe CTS group (2.69 ± 0.39 m/s and 22.4 ± 7.1 kPa) than in the mild CTS group (2.37 ± 0.35 m/s and 17.3 ± 4,8 kPa). The cutoff value for the shear velocity was 2.13 m/s, with 86% and 82% sensitivity and specificity, respectively, and the cutoff value for stiffness was 13.6 kPa, with 87% and 82% sensitivity and specificity. CONCLUSION: MN shear velocity and stiffness are significantly higher in CTS patients. SWE can be used to diagnose CTS and distinguish between patients with mild and severe disease.

Sarcopenia, frailty, and elective surgery outcomes in the elderly: an observational study with 125 patients (the SAFESOE study).

Background: Sarcopenia is a syndrome characterized by loss of muscle mass, strength and function. Frailty, a state of vulnerability with diminished reserves. The measurement of perioperative risk does not include the assessment of these variables, as little is known about how these conditions impact each other. Methods: Observational study with a cross-sectional and a prospective cohort component. Elderly people over 60 years of age, able to walk and to independently perform activities of daily living were consecutively recruited in the preoperative period of non-emergency surgical procedures. Frailty was measured by the modified frailty index (mFI-11). Sarcopenia was measured by: (1) thickness and echogenicity on ultrasound; (2) handgrip strength on dynamometry and (3) gait speed. Data obtained from eight muscle groups were submitted to Principal Component Analysis. Postoperative complications were measured using the Clavien-Dindo scale. Follow-up was performed for 1 year to record readmissions and deaths. Results: Between February and May 2019, 125 elderly people were recruited, median age of 71 years (IQR 65-77), 12% of whom were frail. Frailty was associated with older age, use of multiple medicines, presence of multimorbidity and greater surgical risk according to the American Society of Anesthesiologists (ASA) scale, in addition to lower gait speeds and lower handgrip strength. Frailty was also independently associated with smaller measurements of muscle thickness but not with echogenicity, and with longer hospital and Intensive care unit (ICU) stays. Prevalence of sarcopenia was 14% when considering at least two criteria: low walking speed and low handgrip strength. For muscle thickness, lower values were associated with female gender, older age, frailty, lower gait speeds and lower muscle strength, higher proportion of postoperative complications and higher occurrence of death. For echogenicity, higher values were related to the same factors as those of lower muscle thickness, except for postoperative complications. Lower gait speeds and lower handgrip strength were both associated with higher proportions of postoperative complications, and longer hospital stays. A higher mortality rate was observed in those with lower gait speeds. Conclusion: Sarcopenia was associated with frailty in all its domains. Unfavorable surgical outcomes were also associated with these two conditions.

Thickening of the axillary recess capsule on ultrasound correlates with magnetic resonance imaging signs of adhesive capsulitis.

OBJECTIVE: To correlate the thickness of the axillary recess capsule measured by ultrasound with magnetic resonance imaging signs of adhesive capsulitis in patients with shoulder pain. MATERIALS AND METHODS: We prospectively evaluated 193 consecutive patients (141 women and 52 men, aged 40-69 years) with shoulder pain lasting 1-9 months from January 2015 to December 2016 who underwent shoulder ultrasound. All participants had routine shoulder ultrasound with additional measurement of axillary recess capsule thickness. After examinations, two groups were formed: negative ultrasound group, composed of patients with a capsule thickness of 2.0 mm or less, and positive ultrasound group, composed of individuals with a capsule thickness greater than 2.0 mm. All patients from the positive ultrasound group and 27 randomly chosen patients from the negative ultrasound group underwent shoulder magnetic resonance imaging. RESULTS: In all, 169/193 patients (88%) had an axillary recess capsule thickness of 2.0 mm or less (negative ultrasound group) and 24/193 patients (12%) had a capsule thickness greater than 2.0 mm (positive ultrasound group). Twenty-seven patients from negative ultrasound group (27/169) were randomly selected to undergo shoulder magnetic resonance imaging. None of them had magnetic resonance imaging criteria for adhesive capsulitis. All patients from positive ultrasound group (24/24) underwent shoulder magnetic resonance imaging and 23 of them (23/24) had magnetic resonance imaging signs of adhesive capsulitis, with a sensitivity of 100% and a specificity of 96%. CONCLUSION: In patients with shoulder pain, a thickness greater than 2.0 mm of the axillary recess capsule measured by ultrasound correlates to magnetic resonance imaging signs of adhesive capsulitis with good sensitivity and specificity.

Electromyographic and ultrasonographic characterization of masticatory function in individuals with normal occlusion.

PURPOSE: To characterize the motor control of the masseter and temporal muscles and the morphology of the masseter muscles during mastication in individuals with normal occlusion and to verify the consistency between surface electromyography (sEMG) and ultrasound (USD). METHODS: Participants were 22 adults, of both genders, with no alterations of the oral myofuntional system. The procedures performed included sEMG of the masseter (MM) and temporal (TM) muscles and USD of the MM, each during three tasks: resting condition and maximum voluntary dental clench with and without cotton rolls. RESULTS: The following statistical tests were used: Kolmogorov-Smirnov, paired t-test and Spearman correlation (significance level of 5%). The sEMG data indicated a significant difference between the MM and TM during the maximum voluntary clench with and without cotton rolls, and the TM was more active than the TM in both clenching tasks. No significant difference was observed between the sides of the face when assessed with sEMG or USD. A significant positive correlation between the exams was observed for the left maximum voluntary dental clench with and without cotton rolls, and a trend toward significance was found for the right maximum dental clench without cotton rolls. CONCLUSION: The comparison of sEMG to USD for the investigation of muscle function reveals important information about the physiology of skeletal muscles. The results of the present study suggest a correlation between sEMG and USD, i.e., between increased electrical activity and the corresponding increase in muscle thickness.

Electromyographic and ultrasonographic assessment of the masseter muscle in normal individuals: a pilot study.

BACKGROUND: recent studies have used ultrasonography with the purpose of measuring muscle cuts. AIM: to characterize the motor control and the morphology of the masseter muscle in normal individuals, verifying the compatibility between surface electromyography and ultrasonography. METHOD: five adult individuals, with no alterations of the stomatognathic system. The adopted assessment procedures for all participants were: 1. Surface Electromyography; 2. Ultrasonography. RESULTS: a high correlation was observed only when comparing both hemifaces in the ultrasonographic assessment (rest 0.95; biting 0.86). CONCLUSION: the results indicate that there is no correlation between the tested methods, suggesting that both methods are complementary and not mutually excludent.

Ultrasound features of carpal tunnel syndrome: a prospective case-control study.

PURPOSE: The purpose of the study was to examine the most adequate cut-off point for median nerve cross-sectional area and additional ultrasound features supporting the diagnosis of carpal tunnel syndrome (CTS). MATERIAL AND METHODS: Forty wrists from 31 CTS patients and 63 wrists from 37 asymptomatic volunteers were evaluated by ultrasound. All patients were women. The mean age was 49.1 years (range: 29-78) in the symptomatic and 45.1 years (range 24-82) in the asymptomatic group. Median nerve cross-sectional area was obtained using direct (DT) and indirect (IT) techniques. Median nerve echogenicity, mobility, flexor retinaculum measurement and the anteroposterior (AP) carpal tunnel distance were assessed. This study was IRB-approved and all patients gave informed consent prior to examination. RESULTS: In CTS the median nerve cross-sectional area was increased compared with the control group. Median nerve cross-sectional area of 10 mm(2) (DT) and 9 mm(2) (IT) had high sensitivity (85% and 88.5%, respectively), specificity (92.1% and 82.5%) and accuracy (89.3% and 82.5%) in the diagnosis of CTS. CTS patients had an increased carpal tunnel AP diameter, flexor retinaculum thickening, reduced median nerve mobility and decreased median nerve echogenicity. CONCLUSION: Ultrasound assists in the diagnosis of CTS using the median nerve diameter cut-off point of 10 mm(2) (DT) and 9 mm(2) (IT) and several additional findings.

Caracterização eletromiográfica e ultrassonográfica da função mastigatória em indivíduos com oclusão normal / Electromyographic and ultrasonographic characterization of masticatory function in individuals with normal occlusion

OBJETIVO: Caracterizar o controle motor dos músculos masseter e temporal e a morfologia do músculo masseter em atividades da função mastigatória em indivíduos com oclusão normal; verificar a compatibilidade entre os exames de eletromiografia de superfície (EMGs) e ultrassonografia (USG). MÉTODOS: Participaram 22 indivíduos adultos, de ambos os gêneros, sem alterações no sistema miofuncional orofacial. Os procedimentos adotados para avaliação dos participantes foram: EMGs dos músculos masseteres (MM) e temporais (MT); e USG dos MM, na realização de três tarefas - repouso muscular, apertamento dentário com algodão, apertamento dentário sem algodão. RESULTADOS: Para análise estatística dos dados foram utilizados os testes de Kolmogorv-Smirnov, teste-T pareado e Correlação de Spearman, com nível de significância de 5%. Na EMGs observou-se diferença entre a ativação de MM e MT no apertamento dentário com e sem algodão, sendo MT mais ativo que MM em ambas as tarefas. Não foram observadas diferenças entre as hemifaces, tanto na EMGs quanto na USG. Observou-se também correlação positiva entre os exames na condição de apertamento dentário sem algodão esquerdo e na condição de apertamento dentário esquerdo com algodão, e tendência à significância no apertamento dentário direito sem algodão. CONCLUSÃO: A associação da EMGs e USG na investigação da funcionalidade muscular traz importantes informações sobre fisiologia da musculatura esquelética. Os resultados do presente estudo indicam haver correlação entre a EMGs e a USG, ou seja, o aumento da atividade elétrica e o aumento correspondente da espessura do músculo.

PURPOSE: To characterize the motor control of the masseter and temporal muscles and the morphology of the masseter muscles during mastication in individuals with normal occlusion and to verify the consistency between surface electromyography (sEMG) and ultrasound (USD). METHODS: Participants were 22 adults, of both genders, with no alterations of the oral myofuntional system. The procedures performed included sEMG of the masseter (MM) and temporal (TM) muscles and USD of the MM, each during three tasks: resting condition and maximum voluntary dental clench with and without cotton rolls. RESULTS: The following statistical tests were used: Kolmogorov-Smirnov, paired t-test and Spearman correlation (significance level of 5%). The sEMG data indicated a significant difference between the MM and TM during the maximum voluntary clench with and without cotton rolls, and the TM was more active than the TM in both clenching tasks. No significant difference was observed between the sides of the face when assessed with sEMG or USD. A significant positive correlation between the exams was observed for the left maximum voluntary dental clench with and without cotton rolls, and a trend toward significance was found for the right maximum dental clench without cotton rolls. CONCLUSION: The comparison of sEMG to USD for the investigation of muscle function reveals important information about the physiology of skeletal muscles. The results of the present study suggest a correlation between sEMG and USD, i.e., between increased electrical activity and the corresponding increase in muscle thickness.

Avaliação eletromiográfica e ultrassonográfica do músculo masseter em indivíduos normais: estudo piloto / Electromyographic and ultrasonographic assessment of the masseter muscle in normal individuals: a pilot study

TEMA: estudos recentes utilizaram a ultrassonografia com o objetivo de medir cortes musculares. OBJETIVO: caracterizar o controle motor e a morfologia do músculo masseter em indivíduos normais, verificando a compatibilidade entre a eletromiografia de superfície e a ultrassonografia. MÉTODO: cinco indivíduos adultos, sem alterações no sistema estomatognático. Os procedimentos adotados para a avaliação dos participantes foram: 1. Eletromiografia de Superfície; 2. Ultrassonografia. RESULTADOS: houve alta correlação apenas para a comparação entre hemifaces direita e esquerda no exame de ultrassonografia (repouso 0,95; máxima intercuspidação dentária 0,86). CONCLUSÃO: os resultados indicam não haver correlação entre os métodos testados, sugerindo que os exames são complementares e não excludentes.

BACKGROUND: recent studies have used ultrasonography with the purpose of measuring muscle cuts. AIM: to characterize the motor control and the morphology of the masseter muscle in normal individuals, verifying the compatibility between surface electromyography and ultrasonography. METHOD: five adult individuals, with no alterations of the stomatognathic system. The adopted assessment procedures for all participants were: 1. Surface Electromyography; 2. Ultrasonography. RESULTS: a high correlation was observed only when comparing both hemifaces in the ultrasonographic assessment (rest 0.95; biting 0.86). CONCLUSION: the results indicate that there is no correlation between the tested methods, suggesting that both methods are complementary and not mutually excludent.

Inter- and intrareader variability in the interpretation of two radiographic classification systems for juvenile rheumatoid arthritis.

OBJECTIVE: To evaluate the inter- and intrareader variability for interpretation of a modified Larsen's radiographic classification system for juvenile rheumatoid arthritis (JRA) focused on osteochondral lesions and a conventional Larsen's classification system, compared to a reference MR scoring system of corresponding images. MATERIALS AND METHODS: Seventy-five radiographs of 60 children with JRA, performed within a short interval of time from the MR examinations, were independently evaluated by three experienced radiologists, three diagnostic imaging residents and three rheumatologists, in two separate sessions, according to the two different classification methods, blinded to the corresponding MR images. RESULTS: The inter- and intrareader concordance rates between the two radiographic classification systems and the MR-related radiographs were respectively poor and poor/moderate. The interobserver range of weighted kappa values for the conventional and the modified Larsen's system respectively was 0.25-0.37 vs 0.19-0.39 for radiologists, 0.25-0.37 vs 0.18-0.30 for residents and 0.19-0.51 vs 0.17-0.29 for rheumatologists. The intrareader rate ranged from 0.17-0.55 for radiologists, 0.2-0.56 for residents, and 0.14-0.59 for rheumatologists. CONCLUSION: Although the proposal of a new radiographic classification system for JRA focused on osteochondral abnormalities sounds promising, the low inter- and intrareader concordance rates with an MR-related radiographic system makes the clinical applicability of such a radiographic system less suitable.

Calcinose peritendínea do tendão calcâneo associada a dermatomiosite: correlacão entre radiografia convencional, ultra-sonografia, ressonância magnética e macroscopia cirúrgica / Peritendinous calcinosis of calcaneus tendon associated with dermatomyositis: correlation between conventional radiograph, ultrasound, magnetic resonance imaging and gross surgical pathology

A calcinose intersticial é uma afeccão incomum, na qual existe deposicão de cálcio localizada ou disseminada na pele, tecido celular subcutâneo, músculos e tendões. Freqüentemente a calcinose está associada com doencas do tecido conjuntivo, como esclerodermia e dermatomiosite. Os autores relatam um caso de calcinose intersticial associada a dermatomiosite, estudada com radiografia convencional, ultra-sonografia, ressonância magnética, e com correlacão com a macroscopia cirúrgica.