Confiabilidad Inter-evaluador en la Medición del Grosor Muscular y el Ángulo de Penación a través de la Evaluación Ecográfica: Estudio entre un Experto y un Kinesiólogo en Formación / Inter-Evaluator Reliability in Measurement of Muscle Thickness and Penance Angle through Ultrasound Evaluation: Comparison Study between an Expert and a Physical Therapist in Training

Existen diversas formas de evaluar el músculo esquelético. Una herramienta que ha ganado relevancia es la evaluación ecográfica. Esta, permite medir el grosor muscular (GM) y el ángulo de penación (AP). Por otra parte, en la formación inicial de los Kinesiólogos es importante realizar el ejercicio de la confiabilidad en la medición en relación al experto. un procedimiento diagnóstico. Así, el objetivo de este estudio es determinar la confiabilidad inter-evaluador en la medición del GM y el AP, a través de la evaluación ecográfica, entre un experto y un kinesiólogo en formación. La capacitación contó de tres fases; el ciclo teórico, el ciclo práctico y el proceso de confiabilidad. Para este último, se realizaron 10 pruebas para cada una de las mediciones GM 1, GM 2 y GM 3 y de AP. La confiabilidad inter-evaluador en la medición de GM es buena a excelente en los tres intentos GM1 (ICC=0,81; p=0,001), GM2 (ICC=0,86; p<0,001), GM3 (ICC=0,88;<0,001). Por su parte, la confiabilidad del AP fue pobre a regular (ICC=0,21; p=0,143. Las conclusiones de esta investigación indican que existe una excelente confiabilidad inter evaluador en la medición de GM. No así, en la medición de AP, por lo que se sugiere incrementar las horas prácticas en el proceso de aprendizaje de esta medida.

SUMMARY: Skeletal muscle can be assessed in a number of different ways. Consequently, ultrasound evaluation has become a relevant diagnostic tool. This procedure allows measuring muscle thickness (MT) and pennation angle (PA). Furthermore, during the initial training of physical therapists it is important in a diagnostic procedure, to exercise reliability in measurement in comparison to the expert. Therefore, the objective of this study is to determine the inter-rater reliability in the measurement of MT and PA, through ultrasound evaluation, between an expert and a physical therapist in training. This training was comprised of three phases: The theoretical cycle, the practical cycle and the reliability process. For the latter, ten different tests were performed for each of the MT 1, MT 2 and MT 3 and PA measurements. Inter-rater reliability in the MT measurement was good to excellent in the three attempts MT1 (ICC=0.81; p=0.001), MT2 (ICC=0.86; p<0.001), MT3 (ICC=0. 88;<0.001). On the other hand, reliability of the PA was poor to fair (ICC=0.21; p=0.143. In conclusion, this research indicates that there is excellent inter-rater reliability in the measurement of MT. This does not however apply to the measurement of PA. It is therefore suggested that practical hours during the learning process of this measure be increased.

Localization of the centre of the highest region of the triceps brachii muscle spindle abundance and its significance in muscle spasticity block / Localización del centro de la región más alta del huso del músculo tríceps braquial y su importancia en el bloqueo de la espasticidad muscular

SUMMARY: This study aimed to accurately localize the location and depth of the centre of the highest region of muscle spindle abundance (CHRMSA) of the triceps brachii muscle. Twenty-four adult cadavers were placed in the prone position. The curve connecting the acromion and lateral epicondyle of the humerus close to the skin was designed as the longitudinal reference line (L), and the curve connecting the lateral and the medial epicondyle of the humerus was designed as the horizontal reference line (H). Sihler's staining was used to visualize the dense intramuscular nerve region of the triceps brachii muscle. The abundance of muscle spindle was calculated after hematoxylin and eosin stain. CHRMSA was labelled by barium sulphate, and spiral computed tomography scanning and three- dimensional reconstruction were performed. Using the Syngo system, the projection points of CHRMSA on the posterior and anterior arm surface (P and P' points), the position of P points projected to the L and H lines (PL and PH points), and the depth of CHRMSA were determined. The PL of the CHRMSA of the long, medial, and lateral heads of the triceps brachii muscle were located at 34.83 %, 75.63 %, and 63.93 % of the L line, respectively, and the PH was located at 63.46 %, 69.62 %, and 56.07 % of the H line, respectively. In addition, the depth was located at 34.73 %, 35.48 %, and 35.85 % of the PP' line, respectively. These percentage values are all the means. These body surface locations and depths are suggested to be the optimal blocking targets for botulinum toxin A in the treatment of triceps brachii muscle spasticity.

RESUMEN: Este estudio tuvo como objetivo localizar con precisión la ubicación y la profundidad del centro de la región más alta del huso muscular (CHRMSA) del músculo tríceps braquial. Se colocaron veinticuatro cadáveres adultos en posición prona y se designó la curva que conecta el acromion y el epicóndilo lateral del húmero cerca de la piel como la línea de referencia longitudinal (L), y la curva que conecta los epicóndilos lateral y medial del húmero fue designada como la línea de referencia horizontal (H). Se usó la tinción de Sihler para visualizar la región nerviosa intramuscular densa del músculo tríceps braquial. La abundancia de huso muscular se calculó después de la tinción con hematoxilina y eosina. CHRMSA se marcó con sulfato de bario y se realizó una tomografía computarizada espiral y una reconstrucción tridimensional. Usando el sistema Syngo, fueron determinados los puntos de proyección de CHRMSA en la superficie posterior y anterior del brazo (puntos P y P'), la posición de los puntos P pro- yectados en las líneas L y H (puntos PL y PH) y la profundidad de CHRMSA. Los PL de la CHRMSA de las cabezas larga, medial y lateral del músculo tríceps braquial se ubicaron en el 34,83 %, 75,63 % y 63,93 % de la línea L, respectivamente, y el PH se ubicó en el 63,46 %, 69,62 %, y 56,07 % de la línea H, respectivamente. La profundidad se ubicó en el 34,73 %, 35,48 % y 35,85 % de la línea PP', respectivamente. Estos valores porcentuales son todas las medias. Se sugiere que estas ubicaciones y profundidades de la superficie corporal son los objetivos de bloqueo óptimos para la toxina botulínica A en el tratamiento de la espasticidad del músculo tríceps braquial.

Effects of physical activity in muscle ultrasound evaluation of an older adult population ­ a pilot study / Efeitos da atividade física na avaliação ecográfica muscular de uma população idosa ­ estudo piloto

INTRODUCTION: Insufficient physical activity levels in aging populations have become an increasing challenge. The phenotype of sarcopenia has many causes in addition to aging. The presence of low muscle performance is necessary for diagnosis, in addition to low muscle mass. The ultrasound is an imaging modality with several advantages, making it potentially useful in assessing muscle changes. OBJECTIVE: This pilot study aimed to evaluate muscle morphology changes in older adults after a physical activity program using ultrasound parameters. METHODS: Older adults aged over 60 years were divided into two non-randomized groups in an unblinded trial: an intervention group (n = 18), who took part in a physical activity program for 8 weeks; and a control group, whose members were encouraged to maintain their usual daily routines (n = 16). All the participants were submitted to bilateral quadriceps muscle ultrasound evaluations; the thickness and echo-intensity muscles were analyzed. Only six participants of each group were available for a second evaluation session. The t-test for independent samples was used to evaluate differences between the groups. A t-test for paired samples was performed for the IntG at baseline and post-intervention. RESULTS: Muscle thickness showed a negative correlation with age, while echo-intensity showed a positive correlation. Echo-intensity showed a negative correlation with muscle thickness. There were differences between the groups for both measurement. CONCLUSIONS: A change in muscle morphology was noticeable when a physical activity program was applied in this pilot study. New studies are necessary to confirm these preliminary findings. Ultrasound could be a low-cost objective method for muscle evaluation in physical activity programs assessment in older adults. KEYWORDS: aging; quadriceps muscle, physical activity.

INTRODUÇÃO: Níveis insuficientes de atividade física em populações idosas têm-se tornado um desafio crescente. O fenótipo da sarcopenia pode ter muitas causas além do envelhecimento. A presença de baixo desempenho muscular é necessária para o diagnóstico, além da diminuição da massa muscular. A ecografia é uma modalidade de imagem com diversas vantagens, sendo potencialmente útil na avaliação das alterações musculares. OBJETIVO: Este estudo piloto teve como objetivo avaliar as alterações da morfologia muscular em idosos após um programa de atividade física por meio de parâmetros ecográficos. MÉTODOS: Idosos com mais de 60 anos foram divididos em dois grupos não randomizados em um ensaio não cego: um grupo de intervenção (n = 18), que participou de um programa de atividade física por 8 semanas; e um grupo controle, incentivado a manter a rotina diária usual (n = 16). Todos os participantes foram submetidos a avaliações ecográficas do músculo quadríceps bilateralmente; a espessura e a ecogenicidade dos músculos foram analisadas. Apenas seis participantes de cada grupo estavam disponíveis para uma segunda sessão de avaliação. O teste t para amostras independentes foi usado para avaliar as diferenças entre os grupos. Um teste t para amostras emparelhadas foi realizado para o IntG na linha de base e pósintervenção. RESULTADOS: A espessura muscular apresentou correlação negativa com a idade, enquanto a ecogenicidade apresentou correlação positiva. A ecogenicidade apresentou correlação negativa com a espessura muscular. Houve diferenças entre os grupos para as medidas. CONCLUSÕES: Alterações na morfologia muscular foram perceptível após a aplicação de um programa de atividade física, neste estudo piloto. No entanto, novos estudos são necessários para confirmar esses achados preliminares. A ecografia pode ser um método objetivo de baixo custo para avaliação muscular na verificação da eficácia de programas de atividade física em idosos

Evaluation of adductor pollicis muscle thickness obtained by ultrasonography and adipometer in patients with chronic kidney disease under conservative treatment / Evaluación del polímico adductor espesor muscular obtenido por ultrasonografía y adipómetro en pacientes con enfermedad renal crónico bajo tratamiento conservador

The aim of this study was to evaluate the concordance between adductor pollicis muscle thickness (APMT) measured by ultrasonography and adipometer and the applicability of the measurement as an indicator of the nutritional status of patients with chronic kidney disease (CKD). Methods: Epidemiological study with a cross-sectional design (n= 137). The concordance between APMT assessed by both methods were evaluated by intraclass correlation coefficient. Bland-Altman graphics were produced. APMTs were correlated with body mass index (BMI); calf circumference (CC), brachial circumference (BC) and brachial muscle (BMC); lean tissue mass (LTM); LTM index and body cell mass (BCM) via Pearson correlation. The adipometer overestimated APMT by 7 mm when compared to ultrasonography. APMT measured by adipometer was moderately correlated with BMI, CC, BC, BMC, LTM and BCM. APMT by ultrasonography was weakly correlated with CC, BMC, LTM, and LTM index. Conclusion: APMT presented weak or moderate correlation between methods. The measurement was predictive of muscle mass. We suggest that APMT be used in a complementary way in the evaluation of body composition.

El objetivo de este estudio es evaluar la concordancia entre el espesor de músculo aductor pollicis (EMAP), medido por ecografía y adipómetro, con aplicabilidad de la medición como indicador del estado nutricional de los pacientes con enfermedad renal crónica (ERC). Métodos: Estudio epidemiológico con diseño transversal. La concordancia entre los APMT estimados por ambos métodos se evaluó mediante el coeficiente de correlación intraclase y se diseñaron gráficos de Bland-Altman. En 137 pacientes con ERC, el APMT se correlacionó con índice de masa corporal (IMC); circunferencias de la pantorrilla (CP), circunferencia braquial (CB) y circunferencia del músculo braquial (CMB); masa de tejido magro (MTM); índice de masa magra (IMM) y masa celular corporal (MCC) mediante correlación de Pearson. Se obtuvo que el adipómetro sobreestima EMAP en 7 mm en comparación con la ecografía. EMAP medido por adipómetro se correlacionó moderadamente con IMC, CP, CB, CMB, MTM e IMM. EMAP por ecografía se correlacionó débilmente con el CP, CMB, MTM y IMM. Conclusión: EMAP presentó una baja o moderada correlación con otras mediciones de estado nutricional. La EMAP predice la masa muscular, ya que presentó correlación con marcadores de este compartimento. Se sugiere que EMAPse utilice de manera complementaria en la evaluación de la composición corporal.

Is there something new regarding triceps brachii muscle insertion?

Abstract Purpose: Previous studies have questioned whether the triceps brachii muscle tendon (TBMT) has a double or single insertion on the ulna. Aiming to provide an answer, we describe the anatomy of the TBMT and review a magnetic resonance imaging (MRI) series of the elbow. Methods: Forty-one elbows were dissected to assess the details of the triceps brachii insertion. Elbow plastination slices were analyzed to determine whether there was a space on the TBMT. Magnetic resonance imaging from the records of the authors were also obtained to demonstrate the appearance of the pre-tricipital space on MRI. Results: A virtual space on the medial aspect near the TBTM insertion site in the olecranon was consistently found on anatomic dissections. It was a distal pre-tricipital space. Magnetic resonance imaging demonstrated the appearance of the pre-tricipital space on MRI, and its extension was measured longitudinally either in elbow flexion or extension. There was no statistically significant difference between the measurements of this space in the right and left elbows or between flexion and extension (p > 0.05). The coefficient of variation was <10% for all measurements. Conclusion: Knowledge of this structure may be essential to avoid incorrect diagnosis and unnecessary therapeutic interventions.

Uso da ultrassonografia para avaliar a espessura muscular e a gordura subcutânea em crianças e adolescentes com fibrose cística / The use of ultrasonography to evaluate muscle thickness and subcutaneous fat in children and adolescents with cystic fibrosis

RESUMO Objetivo: Comparar a espessura muscular e a gordura subcutânea entre pacientes com fibrose cística (FC) e controles saudáveis e correlacionar os achados ultrassonográficos com variáveis nutricionais, clínicas e de função pulmonar. Métodos: Foram incluídos sujeitos (6 a 18 anos) com o diagnóstico de FC e indivíduos saudáveis. Foram realizadas medidas antropométricas, avaliação ultrassonográfica da espessura muscular e da gordura subcutânea do tríceps, quadríceps e da região do gastrocnêmio, além da quantificação das pregas cutâneas. O percentual de gordura corporal foi estimado pelas pregas cutâneas. Osindivíduos com FC também tiveram a função pulmonar avaliada por espirometria. Resultados: Foram incluídos 39 pacientes com FC e 45 controles. Ossujeitos com FC apresentaram do índice de massa corporal menor (p=0,011). Acomposição corporal e a espessura muscular foram similares entre os grupos. Apenas a circunferência da panturrilha (p=0,023) e o diâmetro do fêmur (p<0,001) foram menores nos pacientes com FC. Embora sem diferença na comparação dos achados ultrassonográficos da gordura subcutânea, os pacientes com FC apresentaram redução das dobras cutâneas do tríceps (p=0,0031) e do quadríceps (p=0,019). Além disso, observaram-se correlações fracas e moderadas da espessura do quadríceps pelo ultrassom com a capacidade vital forçada (CVF) e massa magra, respectivamente. Também houve correlações moderadas das pregas cutâneas do tríceps, quadríceps e gastrocnêmio com a gordura subcutânea avaliada pela ultrassonografia. Conclusões: Pacientes com FC apresentaram menor espessura da gordura subcutânea. A espessura muscular se correlacionou com a CVF e os parâmetros nutricionais, e a ultrassonografia apresentou correlação positiva com as pregas cutâneas.

ABSTRACT Objective: To compare muscle thickness and subcutaneous fat in cystic fibrosis (CF) patients and healthy controls using ultrasonography (US), and to correlate US findings with nutritional, clinical and functional variables. Methods: Patients aged 6 to 18 years old with a diagnosis of CF and healthy controls were included. Participants underwent anthropometric measurements, an ultrasonographic evaluation of muscle thickness and subcutaneous fat in the triceps, quadriceps, and gastrocnemius regions, and skinfold thickness measurements. Body fat percentage was estimated using skinfold measurement. Subjects with CF also underwent a pulmonary function assessment using spirometry. Results: We studied 39 CF patients and 45 controls. Alower body mass index was observed in CF patients (p=0.011). Body composition and muscle thickness were similar between the groups. Only calf (p=0.023) circumference and femur diameter (p<0.001) were lower in CF patients. Although there were no significant between-group differences in the comparison of US measurements of subcutaneous fat, CF patients exhibited decreased skinfold thickness in the triceps (p=0.031) and quadriceps (p=0.019). Moreover, there were weak and moderate correlations of US quadricep thickness with forced vital capacity (FVC) and lean mass, respectively. Moderate correlations of the triceps, quadriceps and gastrocnemius between US subcutaneous fat and skinfold measurements were found. Conclusions: Patients with CF presented a reduction in subcutaneous fat content. Muscle thickness correlated with FVC and nutritional parameters. In addition, US findings correlated positively with skinfold measurements.

Localization of the nerve entry points of thigh adductor muscles by spiral computed tomography: a novel anatomical guide for chemical neurolysis in treating muscle spasticity / Localización de los puntos de entrada del nervio de los músculos aductores del muslo mediante tomografía computarizada espiral: una nueva guía anatómica para la neurolosis química en el tratamiento de la espasticidad muscular

The nerve entry points (NEPs) cannot yet be accurately localized for the treatment of thigh adductor muscles spasticity in chemical neurolysis. The aim of this study was to identify the location and depth of the NEPs of thigh adductor muscles by spiral computed tomography (CT) and bony landmarks. Forty lower limbs of twenty adult cadavers were dissected in supine position. A curved line on skin surface from the tip of greater trochanter of femur to the center of pubic tubercle was designated as the horizontal reference line (H). Another curved line from the tip of great trochanter to the lateral epicondyle of femur was designated as the longitudinal reference line (L). Following dissection, the NEPs were labeled with barium sulfate, and their body surface projection points (P) were determined by spiral CT. Projection of NEP in the opposite direction was designated as P'. The percentage location of the intersections (PH and PL) of P with the H and L and the percentage depth of NEPs were determined with the Syngo system. The PH for the NEP of pectineus, gracilis, adductor longus, adductor brevis and adductor magnus muscles branch were located at 76.41±0.71 %, 93.85±2.07 %, 92.05±2.15 %, 80.75±1.20 % and 88.08±1.09 % of the H, respectively. The PLwere at 1.64±0.04 %, 29.89±1.90 %, 16.06±1.32 %, 11.66±0.11 % and 22.94±0.90 % of the L, respectively. The depth of NEP from P points were at 17.52±0.52 %, 38.38±2.75 %, 20.88±0.79 %, 20.35±0.82 % and 39.52±0.67 % of PP', respectively. These results help to carry out more precise localization of the NEPs. It should provide a novel anatomical guide for improving the efficacy and efficiency of chemical neurolysis in treating thigh adductor muscle spasticity.

Aún no se pueden localizar con precisión los puntos de entrada del nervio (PEN) para el tratamiento de la espasticidad de los músculos aductores del muslo a través de la neurólisis química. El objetivo de este estudio fue identificar la ubicación y la profundidad de los PEN de los músculos aductores del muslo mediante tomografía computarizada espiral (TC) y puntos de referencia óseos. Se disecaron loa miembros inferiores de 20 cadáveres adultos en posición supina. Se trazó una línea curva en la superficie de la piel desdeel ápice del trocánter mayor del fémur hasta el centro del tubérculo púbico y se designó como línea de referencia horizontal (H). Otra línea curva desde el ápice del trocánter mayor hasta el epicóndilo lateral del fémur se designó como línea de referencia longitudinal (L). Después de la disección, los PEN se marcaron con sulfato de bario y sus puntos de proyección de la superficie del cuerpo (P) se determinaron mediante TC helicoidal. La proyección de PEN en la dirección opuesta se designó como P '. El porcentaje de ubicación de las intersecciones (PH y PL) de P con H y L y la profundidad porcentual de los PEN se determinaron con el sistema Syngo. Los PH para los PEN de los músculos pectineus, gracilis, adductor longus, aductor brevis y rama aductora del músculo aductor magnus se localizaron en 76,41±0,71 %, 93,85±2,07 %, 92,05±2,15 %, 80,75±1,20 % y 88,08±1,09 % de H, respectivamente. Los PL estuvieron en 1,64±0,04 %, 29,89±1,90 %, 16,06±1,32 %, 11,66±0,11 % y 22,94±0,90 % de la L, respectivamente. La profundidad de PEN de P puntos fue de 17,52±0,52 %, 38,38±2,75 %, 20,88±0,79 %, 20,35±0,82 % y 39,52±0,67 % de PP ', respectivamente. Estos resultados ayudan a realizar una localización más precisa de los PEN. Se debe proponer una nueva guía anatómica para mejorar la eficacia y la eficiencia de la neurólisis química en el tratamiento de la espasticidad del músculo aductor del muslo.

Anatomical parameters of the rectus capitis posterior major and obliqus capitis inferior muscles based on an oblique sagittal magnetic resonance scan method / Parámetros anatómicos de los músculos recto posterior mayor de la cabeza y oblicuo mayor de la cabeza basados en un método oblicuo sagital de exploración por resonancia magnética

The deep suboccipital muscles has been shown to connect the spinal dura mater via dense connective tissue termed the myodural bridge (MDB). The MDB has both physiological and clinical implications. Data on morphological and imaging anatomical parameters of the deep suboccipital muscles are scare. In this study, T2-weighted images of rectus capitis posterior major (RCPma) and obliqus capitis inferior (OCI) of 109 healthy adults were obtained by 0-degree sagittal and 30-degree oblique sagittal continuous MRI scanning of the head and neck of the subjects. Sectional area parameters of the RCPma and the OCI were measured. The 0-degree sagittal section was measured with 5 mm bias from the median sagittal plane, the sectional area of the RCPma was 186.34± 55.02 mm2 on the left, and 202.35± 59.76 mm2 on the right. The sectional area of OCI was 221.72± 68.99 mm2 on the left, and 224.92± 61.34 mm2 on the right; At the section with 30-degree bias from the oblique sagittal plane, the sectional area of RCPma was 183.30± 42.24 mm2 in males, and 133.05± 26.44 mm2 in females. The sectional area of OCI was 254.81± 46.20 mm2 in males, and 167.42± 27.85 mm2 in females. Significant sex difference exists in the sectional areas of the RCPma and OCI, the values of the male subjects were predominantly larger (P < 0.05), however there were no age- related significant difference. The sectional area of RCPma is bilateral asymmetric, the RCPma on the right side is larger than that of the left side (P < 0.05), but the OCI is bilaterally symmetric (P >0.05). The MRI image features, imaging anatomical data and sexual dimorphism of the RCPma and the OCI are presented in this study. This imaging anatomical data will be useful for functional and clinical studies on the RCPma, OCI, and the MDB.

Se ha demostrado que los músculos suboccipitales profundos conectan la duramadre espinal a través del tejido conectivo denso denominado puente miodural (PMD). El PMD tiene implicaciones tanto fisiológicas como clínicas. Los datos sobre los parámetros anatómicos y morfológicos y de imagen de los músculos suboccipitales profundos son alarmantes. En este estudio, se obtuvieron imágenes ponderadas en T2 del músculo recto posterior mayor (RCPma) y del músculo oblicuo mayor de la cabeza (OCI) de 109 adultos sanos, mediante una exploración de la cabeza y el cuello sagital de 0 grados y sagital oblicua de 30 grados. Se midieron los parámetros de área seccional del RCPma y el OCI. La sección sagital de 0 grados se midió con un sesgo de 5 mm desde el plano mediano, el área de la sección de la RCPma fue 186,34 ± 55,02 mm2 a la izquierda y 202,35 ± 59,76 mm2 a la derecha. El área seccional de OCI fue 221.72 ± 68.99 mm2 a la izquierda y 224.92 ± 61.34 mm2 a la derecha. En la sección de 30 grados desde el plano sagital oblicuo, el área de la sección de RCPma fue de 183.30 ± 42.24 mm2 en los hombres, y 133.05 ± 26.44 mm2 en las mujeres. El área seccional de OCI fue de 254.81 ± 46.20 mm2 en varones y 167.42 ± 27.85 mm2 en mujeres. Existe una diferencia significativa según el sexo en las áreas seccionales de la RCPma y la OCI, los valores de los sujetos masculinos fueron predominantemente mayores (P <0.05). Sin embargo, no hubo diferencia significativa relacionada con la edad. El área de la sección de RCPma es bilateral asimétrica, la RCPma en el lado derecho es más grande que la del lado izquierdo (P <0.05), pero el OCI es bilateralmente simétrico (P> 0.05). Las características de la imagen de resonancia magnética, los datos anatómicos de imágenes y el dimorfismo sexual de la RCPma y la OCI se presentan en este estudio. Estos datos anatómicos de imágenes serán útiles para estudios funcionales y clínicos en RCPma, OCI y PMD.

Lesiones musculares deportivas: correlación entre anatomía y estudio por imágenes / Muscle injuries in sports: imaging study

Un gran segmento de la población participa en actividades deportivas. Las lesiones musculares corresponden a aproximadamente un tercio de las lesiones deportivas. Las demandas recreacionales y profesionales de la sociedad moderna exigen un diagnóstico precoz y preciso, para un adecuado tratamiento y seguimiento, dadas las implicancias económicas y mediáticas, especialmente en deportistas de elite. La imagenología tiene un rol fundamental en la evaluación de estas lesiones. Permite evaluar localización, extensión, severidad y estimar pronóstico, así como también el seguimiento para determinar el retorno deportivo. En este artículo se revisa la anatomía microscópica y macroscópica muscular, la fisiología, los tipos de lesiones y su representación en imágenes, tanto en ultrasonido (US), como en resonancia magnética (RM). Se mencionan distintas clasificaciones descritas en la literatura y se propone una nueva nomenclatura y descripción, basada principalmente en la anatomía muscular, la localización y cuantificación de las lesiones.

A large segment of the population participates in sporting activities. Muscle injuries account for approximately one-third of the injuries. The recreational and professional demands of modern society require an early and precise diagnosis of these, for an adequate treatment and follow-up, given the economic and media implications, especially in elite athletes1. Imaging plays a fundamental role in the evaluation of these lesions. It allows evaluation location, extent, severity and estimations of prognosis, as well as the follow-up to determine the return to sport. This article reviews the microscopic and macroscopic muscle anatomy, the physiology, types of lesions and their representation in images, both in ultrasound (US) and magnetic resonance (MRI). Different classifications described in the literature are mentioned and a nomenclature and description is proposed, based mainly on the muscle anatomy, localization and type of injury.

Acute effects of passive static stretching on the vastus lateralis muscle architecture of healthy young men / Efeitos agudos do alongamento estático passivo sobre a arquitetura muscular do vasto lateral de jovens saudáveis

Abstract The aim of the study was to investigate the acute effects of passive static stretching (PSS) on the fascicle length (FL) and fascicle angle (FA) of the vastus lateralis muscle (VL) in two different joint positions. Twelve physically active men (26.9 ± 7.5 years, 178.6 ± 7.0 cm, and 82.5 ± 16.8 kg) were placed in the prone position for the acquisition of ultrasound images (US) of VL, registered with extended and totally flexed knee up to the heel contact with the gluteus, before and after a PSS routine comprised of three 30-s repetitions maintained in the maximal discomfort position as reported by the participant. Results of the paired t-test indicated an increase in FL (16.2%; p = 0.012) and reduction in FA (15.5%; p = 0.003) in pre vs. post stretching comparisons for the extended knee position. There was also a significant increase in FL (34%; p = 0.0001) and reduction in FA (25%; p = 0.0007) when compared the extended knee vs. flexed knee positions. There were no significant differences in muscle architecture variables for the flexed knee position. The results showed high and moderate correlation of FL and FA for the extended (r = -0.89 and r = -0.74) and flexed knee (r = -0.76 and r = -0.78) position, pre and post stretching, respectively. It was concluded that the static stretching acutely affects the vastus lateralis muscle architecture only in the extended knee position, but not in the flexed knee position.

Resumo O objetivo do estudo foi verificar os efeitos agudos do alongamento estático passivo (AEP) sobre o comprimento (CF) e ângulo do fascículo (AF) do músculo vasto lateral (VL) em duas diferentes posições articulares. Doze homens (26,9 ± 7,5 anos; 178,6 ± 7,0 cm; e 82,5 ± 16,8 kg), fisicamente ativos foram posicionados em decúbito ventral para aquisição de imagens de ultrassonografia (US) do VL, registradas com joelho estendido e totalmente flexionado, até o conato do calcanhar com o glúteo, antes e após uma rotina de AEP composta por três repetições de 30 s com manutenção da posição no limite de desconforto relatado pelo participante. O teste t de Student para amostras pareadas indicou aumento no CF (16,2%; p = 0,012) e redução no AF (15,5%; p = 0,003) nas comparações pré vs. após alongamento na posição com o joelho estendido. Também houve aumento significativo do CF (34%; p = 0,0001) e redução do AF (25%; p = 0,0007) na comparação entre as posições de joelho estendido vs. flexionado. Não foram encontradas diferenças significativas nas variáveis da arquitetura muscular investigadas na posição com o joelho flexionado. Os resultados apontaram para correlação alta e moderada do CF e AF com joelho estendido (r = -0,89 e r = -0,74) e joelho flexionado (r = -0,76 e r = -0,78), pré e após alongamento, respectivamente. Concluiu-se que o alongamento estático afeta de forma aguda a arquitetura muscular do vasto lateral apenas na posição de joelho estendido, mas não na posição com joelho flexionado.

Ruptura del músculo cuadrado crural / Quadratus femoris muscle tear

Resumen: Antecedentes: La ruptura del músculo cuadrado crural es una lesión poco frecuente que se manifiesta por dolor en cadera y cuya incidencia se desconoce. El paciente puede manifestar dolor en región glútea y/o inguinal, su diagnóstico clínico es difícil por su rareza y porque el diagnóstico diferencial de problemas de cadera es amplio. Caso clínico: Masculino de 65 años con dolor en regiones glútea e inguinal derechas manifestadas durante la práctica de tenis, evaluado por neurología con resonancia magnética nuclear (RMN) lumbosacra (normal) y canalizado a rehabilitación. Se solicitó RMN de pelvis, la cual reveló ruptura del cuadrado crural derecho no sospechada previamente. Conclusión: La RMN por su capacidad para mostrar cortes multiplanares es el estudio de elección en problemas de tejidos blandos en cadera, ya que permite localización y auxilia en diagnóstico de problemas no sospechados.

Abstract: Background: Quadratus femoris tear is an uncommon injury that usually cause hip pain, it incidence is unknown. The patient can suffer of posterior gluteal pain or groin pain or both, which makes accurate diagnosis difficult, because the differential diagnosis of hip pain is broad. Clinical case: A 65 years old male, with gluteal and groin pain presented during tennis; evaluated by neurologist with lumbosacral magnetic resonance imaging (MRI) (normal) and referred to physical therapy, a pelvic MRI was required, finding an unsuspected quadratus femoris tear. Conclusion: MRI with its superior soft-tissue resolution and multiplanar capability is an excellent adjunct to physical examination because it shows the anatomic location of the abnormality, aiding the clinician to make unsuspected diagnoses.

Achados ultrassonográficos osteomusculares na paracoccidioidomicose / Musculoskeletal ultrasound findings in paracoccidioidomycosis

Resumo A paracoccidioidomicose é uma infecção fúngica endêmica na América do Sul. A infecção geralmente é assintomática e afeta principalmente os tratos respiratórios superior e inferior, com dissociação clínico-radiológica. O envolvimento articular é raro, sem um padrão ou lesão radiológica específica. Apresenta-se um relato de caso de paracoccidioidomicose em que os sintomas iniciais do paciente foram rouquidão e artrite. Depois de um exame de ultrassonografia, foram feitos o diagnóstico diferencial de outras artropatias não infecciosas e a análise do material coletado, que revelou infecção pelo fungo Paracoccidioides brasiliensis.

Abstract Paracoccidioidomycosis is a fungal infection endemic to South America. The infection is usually asymptomatic and mostly affects the upper and lower respiratory tracts with clinical–radiological dissociation. Joint involvement is rare with no specific pattern or radiological injury. We report a case of paracoccidioidomycosis in which the patient's initial symptoms were hoarseness and arthritis. After an ultrasound examination, we performed the differential diagnosis of other noninfectious arthropathies and analysis of the material collected, which revealed infection with the fungus Paracoccidioides brasiliensis.

Ultrasound biomicroscopy and claudication test for in vivo follow-up of muscle repair enhancement based on platelet-rich plasma therapy in a rat model of gastrocnemius laceration

PURPOSE: To track the regeneration process of lateral gastrocnemius due to a muscle laceration in rats, and to treatment with plateletrich plasma (PRP). METHODS: Ultrasound (40 MHz) images were used for measuring pennation angle (PA), muscle thickness (MT) and mean pixel intensity, along with claudication scores, of treated (PRPG) and non-treated (NTG) groups of rats. RESULTS: NTG showed a PA increase for the non-injured leg (p<0.05) and a tendency of MT to increase, whereas for PRPG there were no differences. There was a progressive reduction of the claudication score for the PRPG group throughout the entire period, with an immediate difference after seven days (p<0.05), whereas the NTG had a significant reduction only at day 28 (p<0.05). CONCLUSION: It was observed a compensatory hypertrophic response due to the overload condition imposed to healthy leg for NTG that did not occur in PRPG, suggesting an accelerated repair process of the injured leg due to treatment, anticipating its use.

Variabilidad en la determinación de fracción grasa muscular en resonancia magnética utilizando la técnica de Dixon / Variability in magnetic resonance quantification of muscle fat fraction using Dixon's technique

Abstract. Muscle MRI has emerged as a valuable tool in the diagnosis of neuromuscular-disorders. The Dixon fat-water separation technique allows objective intra-muscular fat quantification. There are few reports concerning measurement standardisation with Dixon technique. The objective of this study was to evaluate the variability in fat quantification using Dixon's technique in a cohort of patients with congenital myopathies, by analysing intra-segment, intra-muscle, and inter-muscle variability of 60 muscles in each patient. Whole body MRI was performed on 31 patients, 23 with congenital myopathies and 8 healthy controls, aged between 10 months and 35 years old, from January 2014 to June 2016. The mean fat-fraction in healthy patients was around 5%, with less than 2% intra-muscle variability. An intra-muscle variability between 3.1-7.8% was estimated in patients with congenital myopathies. It may be concluded that there is high intra- and inter-muscle fat-fraction variability among patients with congenital myopathies, and this is an observation that should be incorporated in the analysis of fat replacement.

Resumen. La resonancia magnética muscular ha emergido como una valiosa herramienta de apoyo diagnóstico en enfermedades neuromusculares. La técnica de Dixon permite objetivar la fracción grasa muscular, pero no existe consenso sobre la estandarización de estas mediciones. El objetivo de este estudio fue evaluar la variabilidad en la determinación de fracción grasa utilizando la técnica de Dixon, estudiando la variabilidad intrasegmentaria, intramuscular e intermuscular en 60 músculos por paciente. Se realizó RM de cuerpo completo a 31 pacientes: 23 con miopatía congénita y 8 controles, entre 10 meses y 35 años de edad, desde enero del 2014 a junio del 2016. En pacientes sanos se estimó una fracción grasa promedio cercana al 5%, con una variabilidad intramuscular inferior al 2%. En pacientes con miopatías congénitas existe una variabilidad entre el 3,1-7,8%. El estudio permite concluir que existe una alta variabilidad intra e intermuscular en pacientes miopáticos, que no se observa en pacientes sanos.

Botulinum Toxin Type A Injection for Spastic Equinovarus Foot in Children with Spastic Cerebral Palsy: Effects on Gait and Foot Pressure Distribution

PURPOSE: To investigate the effect of intramuscular Botulinum toxin type A (BoNT-A) injection on gait and dynamic foot pressure distribution in children with spastic cerebral palsy (CP) with dynamic equinovarus foot. MATERIALS AND METHODS: Twenty-five legs of 25 children with CP were investigated in this study. BoNT-A was injected into the gastrocnemius (GCM) and tibialis posterior (TP) muscles under the guidance of ultrasonography. The effects of the toxin were clinically assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS), and a computerized gait analysis and dynamic foot pressure measurements using the F-scan system were also performed before injection and at 1 and 4 months after injection. RESULTS: Spasticity of the ankle plantar-flexor in both the MAS and MTS was significantly reduced at both 1 and 4 months after injection. On dynamic foot pressure measurements, the center of pressure index and coronal index, which represent the asymmetrical weight-bearing of the medial and lateral columns of the foot, significantly improved at both 1 and 4 months after injection. The dynamic foot pressure index, total contact area, contact length and hind foot contact width all increased at 1 month after injection, suggesting better heel contact. Ankle kinematic data were significantly improved at both 1 and 4 months after injection, and ankle power generation was significantly increased at 4 months after injection compared to baseline data. CONCLUSION: Using a computerized gait analysis and foot scan, this study revealed significant benefits of BoNT-A injection into the GCM and TP muscles for dynamic equinovarus foot in children with spastic CP.

Aspectos distintos de ressonância magnética de músculos entre dermatomiosite e polimiosite / Different aspects of magnetic resonance imaging of muscles between dermatomyositis and polymyositis

Introdução: Embora a dermatomiosite (DM) e a polimiosite (PM) compartilhem diversos aspectos clínicos em comum, cada uma delas apresenta características fisiopatológicas e histológicas próprias. É possível que estas diferenças também se reflitam macroscopicamente, como, por exemplo, em imagens musculares vistas em ressonância magnética (RM). Objetivos: Comparar simultaneamente a RM de diversos compartimentos musculares das coxas de pacientes com DM e PM adultos. Materiais: Estudo transversal, em que foram avaliadas, entre o período de 2010 a 2013, as imagens de RM das coxas realizadas em aparelho de 1,5 Tesla (T) com sequências ponderadas em T1 e T2 com supressão de gordura, para rastreamento, de 11 DM e 11 PM (Bohan e Peter, 1975) recém-diagnosticados, em atividade clínica e laboratorial. Resultados: A média de idade na ocasião da RM, o tempo entre o início de sintomas e a realização das RM, a distribuição de sexos e a terapia medicamentosa foram comparáveis entre os dois grupos (p>0,050). Em termos de RM, edema muscular foi encontrado significantemente em DM, e principalmente na região proximal dos músculos. A área de lipossubstituição dos músculos foi encontrada predominantemente em PM. Essa lipossubstituição, quando de uma forma parcial, ocorreu principalmente nos terços médio e distal, enquanto que a forma total transcorreu apenas no terço distal dos músculos. Não houve nenhuma área de fibrose muscular. Conclusões: A DM e a PM apresentam características distintas entre si em RM de músculos, a exemplo de distinções fisiopatológicas e histológicas. .

Introduction: Although dermatomyositis (DM) and polymyositis (PM) share many clinical features in common, they have distinct pathophysiological and histological features. It is possible that these distinctions reflect also macroscopically, for example, in muscle alterations seen in magnetic resonance images (MRI). Objectives: To compare simultaneously the MRI of various muscle compartments of the thighs of adult DM and PM. Materials: The present study is a cross-sectional that included, between 2010 and 2013, 11 newly diagnosed DM and 11 PM patients (Bohan and Peter's criteria, 1975), with clinical and laboratory activity.They were valued at RM thighs,T1 and T2 with fat suppression, 1.5 T MRI scanner sequences. Results: The mean age at the time of MRI, the time between onset of symptoms and the realization of the MRI distribution of sex and drug therapy were comparable between the two groups (p>0.050). Concerning the MRI, muscle edema was significantly found in DM, and mainly in the proximal region of the muscles. The area of fat replacement was found predominantly in PM. The partial fat replacement area occurred mainly in the medial and distal region, whereas the total fat replacement area occurred mainly in the distal muscles. There was no area of muscle fibrosis. Conclusions: DM and PM have different characteristics on MRI muscles, alike pathophysiological and histological distinctions. .

Histological and radiographic evaluation of the muscle tissue of rats after implantation of bone morphogenic protein (rhBMP-2) in a scaffold of inorganic bone and after stimulation with low-power laser light.

Objective: The present study histologically and radiologically evaluates the muscle tissue of rats after implantation of bone morphogenic protein (rhBMP-2) in a natural inorganic bone mineral scaffold from a bull calf femur and irradiation with low-power light laser. Materials and Methods: The right and left hind limbs of 16 rats were shaved and an incision was made in the muscle on the face corresponding to the median portion of the tibia, into which rhBMP-2 in a scaffold of inorganic bone was implanted. Two groups of limbs were formed: control (G1) and laser irradiation (G2). G2 received diode laser light applied in the direction of the implant, at a dose of 8 J/cm2 for three minutes. On the 7th, 21st, 40th and 112th days after implantation, hind limbs of 4 animals were radiographed and their implants removed together with the surrounding tissue for study under the microscope. The histological results were graded as 0=absence, 1=slight presence, 2=representative and 3=very representative, with regard to the following events: formation of osteoid structure, acute inflammation, chronic inflammation, fibrin deposition, neovascularization, foreign-body granuloma and fibrosis. Results: There were no statistically significant differences in these events at each evaluation times, between the two groups (P>0.05; Mann-Whitney test). Nevertheless, it could be concluded that the natural inorganic bone matrix with rhBMP-2, from the femur of a bull calf, is a biocompatible combination. Conclusions: Under these conditions, the inductive capacity of rhBMP-2 for cell differentiation was inhibited. There was a slight acceleration in tissue healing in the group that received irradiation with low-power laser light.