The Relationship Among Probable SARCopenia, Osteoporosis and SuprasPinatus Tendon Tears in Postmenopausal Women: The SARCOSP Study.

We aimed to investigate the relationship among probable sarcopenia, osteoporosis (OP) and supraspinatus tendon (SSP) tears in postmenopausal women. Postmenopausal women screened/followed for OP were recruited. Demographic data, comorbidities, exercise/smoking status, and handgrip strength values were recorded. Probable sarcopenia was diagnosed as handgrip strength values < 20 kg. Achilles and SSP thicknesses were measured using ultrasound. Among 1443 postmenopausal women, 268 (18.6%) subjects had SSP tears. Unilateral tears were on the dominant side in 146 (10.1%) and on the non-dominant side in 55 women (3.8%). In contrast to those without, women with SSP tears had older age, lower level of education, thinner SSP and lower grip strength (all p < 0.05). In addition, they had higher frequencies of hypertension, hyperlipidemia, DM, OP and probable sarcopenia, but lower exercise frequency (all p < 0.05). Binary logistic regression modeling revealed that age [odds ratio (OR): 1.046 (1.024-1.067 95% CI)], hypertension [OR: 1.560 (1.145-2.124 95% CI)], OP [OR: 1.371 (1.022-1.839 95% CI)] and probable sarcopenia [OR: 1.386 (1.031-1.861 95% CI)] were significant predictors for SSP tears (all p < 0.05). This study showed that age, presence of hypertension, probable sarcopenia and OP were related with SSP tears in postmenopausal women. To this end, although OP appeared to be related to SSP tears, SSP tear/thickness evaluation can be recommended for OP patients, especially those who have other risk factors such as older age, higher BMI, hypertension, and probable sarcopenia.

Thoracolumbar fascia and chronic low back pain in idiopathic lumbar scoliosis: an ultrasonographic study.

PURPOSE: The role of thoracolumbar fascia (TLF) in the development of chronic low back pain (CLBP) has growing evidence in the literature. Although CLBP is reported in individuals with idiopathic scoliosis (IS), its relationship with the TLF has yet not been established. This study aims to evaluate the TLF and its relationship with CLBP in IS. METHODS: A total of 60 individuals were included in the study. They were divided into three groups as follows: painful scoliosis (n = 20, age: 17.1 ± 3.7 years, Cobb angle: 15-43°), non-painful scoliosis (n = 20, age: 16.4 ± 3.4 years, Cobb angle: 15-45°), and healthy group (n = 20, age: 16.4 ± 4.7 years). Pain was evaluated using the short form of the McGill Pain Questionnaire. TLF thickness was evaluated on the lumbar region using ultrasonography. Trunk range of motion was assessed using a universal goniometer, and flexibility was assessed with sit-and-reach test. RESULTS: The thickness of the right TLF was greatest in the painful group, followed by non-painful (p = 0.007) and healthy (p < 0.001) groups. The thickness of the left TLF in the non-painful and painful groups was greater compared to the healthy group (p < 0.001). In the painful group, right TLF thickness was negatively correlated with trunk flexion/extension (r = -0.540, p = 0.014/r = -0.514, p = 0.020) and left rotation (r = -0.499, p = 0.025) but positively correlated with pain (r = 0.562, p = 0.01). CONCLUSIONS: Thickening of the TLF was observed in IS, whereby, in the presence of CLBP, it was further intensified. We suggest considering fascial thickening as a potential contributing factor to both pain and limited motion in relevant patients.

"Prompt" for PREEMPT: Dotting the I's and Crossing the T's With Ultrasound.

The management of chronic migraine (CM) underwent a significant shift with the introduction of onabotulinumtoxin A (BoNT-A) injections following the landmark PREEMPT trial in 2010. Despite its efficacy, the existing injection protocol lacks precision, prompting a call for revision in light of modern ultrasound (US)-guided techniques. This article highlights the potential of US-guided injections to enhance accuracy, safety, and efficacy in CM treatment. By providing real-time visualization and addressing anatomical variations, US guidance offers a promising avenue for optimizing BoNT-A delivery, minimizing adverse effects, and ensuring therapeutic success.

Blood Flow Restriction Training in Patients With Rotator Cuff Tendinopathy: A Randomized, Assessor-Blinded, Controlled Trial.

OBJECTIVES: To investigate the effects of low-load blood flow restriction (BFR) training on shoulder muscle thickness, rotator cuff (RC) strength, and shoulder symptoms in patients with RC tendinopathy. DESIGN: A randomized, assessor-blinded, controlled trial. SETTINGS: Physiotherapy clinic at a university. PARTICIPANTS: Twenty-eight patients were randomized into an 8-week (2 times/week) shoulder rehabilitation, that is, BFR or non-BFR group. INTERVENTIONS: BFR training. MAIN OUTCOME MEASURES: (1) RC, deltoid, scapula retractor, and biceps muscle thicknesses and shoulder internal rotation (IR) and external rotation (ER) strengths. (2) Shoulder pain/function. RESULTS: The BFR group had a greater increase in biceps muscle thickness ( P = 0.002) and shoulder IR strength at 60 degrees/s ( P = 0.040) than the non-BFR group. No differences between the 2 groups were observed in other measurements. Significant improvements in supraspinatus, infraspinatus, and scapula retractor muscle thicknesses and in shoulder ER and IR strengths were observed over time in both the groups (all P < 0 .05). Also, shoulder pain decreased and shoulder function increased over time in both the groups (all P < 0 .05). CONCLUSIONS: Low-load BFR training resulted in a greater increase in biceps thickness and shoulder IR strength compared with the non-BFR group in patients with RC tendinopathy. However, there was no superiority of either exercise training regarding the RC, scapula retractor, deltoid muscle thicknesses, or improvements in shoulder ER strength and shoulder pain/function. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: The study was registered in ClinicalTrials.gov named Blood Flow Restriction Training in Patients with Shoulder Pain and the registration number is NCT04333784.

Superficial retrocalcaneal bursae and nerves: From anatomy to ultrasound-guided procedures.

The pertinent literature widely describes ultrasound-guided procedures targeting the retrocalcaneal bursa and the tendon tissue to manage insertional Achilles tendinopathy. Synovial bursae and cutaneous nerves of the superficial retrocalcaneal pad are often overlooked pain generators and are poorly considered by clinicians and surgeons. A layer-by-layer dissection of the superficial soft tissues in the retrocalcaneal region of two fresh frozen cadavers was matched with historical anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob). An accurate and detailed description of the superficial retrocalcaneal pad with its synovial bursae and cutaneous nerves was provided. Cadaveric dissections confirmed the compartmentalized architecture of the superficial retrocalcaneal fat pad and its histological continuum with the superficial lamina of the crural fascia. Superficial synovial tissue islands have been demonstrated on the posterior aspect of the Achilles tendon in one cadaver and on the posterolateral surface of the tendon in the other one. Digitalization of the original anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob) showed five potential locations of the superficial calcaneal bursa and a superficial retrocalcaneal nerve plexus within the Achilles tendon-fat pad interface. In clinical practice, in addition to the previously described interventions regarding the retrocalcaneal bursa and the tendon tissue, ultrasound-guided procedures targeting the synovial and neural tissues of the superficial retrocalcaneal pad should be considered to optimize the management of insertional Achilles tendinopathy.

Myxofibrosarcoma involving the sciatic nerve: From ultrasonography to histopathology.

Myxofibrosarcoma (MFS) is a unique soft tissue (fibroblastic) sarcoma, characterized by malignant with a locally infiltrative behavior. In this case image, we aimed to report an uncommon/challenging scenario of MFS involving the scatic nerve in which the potential contribution of ultrasound examination has been touched upon.

Immediate effects of Kinesio taping in carpal tunnel syndrome: A randomized controlled double-blind ultrasonographic study.

BACKGROUND: The effects of Kinesio taping (KT) in carpal tunnel syndrome are controversial. PURPOSE: This study aimed to examine whether KT has any effect on the skin, subcutaneous tissue, and median nerve measurements and to compare the effects of two different KT applications. STUDY DESIGN: This is a prospective, double-blinded, randomized trial. This study was prospectively registered on the clinicaltrials.gov (NCT05475197). A total of 34 wrists (21 patients) who were clinically and electrophysiologically diagnosed with mild/moderate carpal tunnel syndrome were randomly divided into two KT intervention groups (group 1: neural technique and area correction technique and group 2: area correction technique). METHODS: At baseline and immediately after the removal of KT (48 hours), pain was assessed with visual analog scale, hand grip strength with a hand-held dynamometer, and pinch strength using a pinch meter. Likewise, using ultrasound, skin and subcutaneous tissue thicknesses, median nerve cross-sectional area and flattening ratio, as well as median nerve depth were measured at the carpal tunnel inlet and outlet levels. RESULTS: While there was significant improvement in the pain scores (compared to the baseline) immediately after the KT in both groups (group 1: p = 0.03, ηp2 = 0.44; group 2: p < 0.001, ηp2 = 0.71), there was no difference in between (p = 0.07, ηp2 = 0.10). Grip strength significantly increased only in group 2 (p = 0.01, ηp2 = 0.35). None of the sonographic measurements displayed significant difference either within or between groups at baseline and after KT (all p > 0.05). CONCLUSIONS: While pain scores improved after KT, they were not coupled with any morphologic changes assessed by ultrasound.

Ultrasound-guided injection of the ankle joint: cadaveric investigation of the anterolateral approach.

OBJECTIVE: Injection of the tibiotalar (TT) joint is commonly performed in clinical practice under ultrasound (US) guidance using an anteromedial approach. However, in some patients, this approach may be technically challenging due to post-traumatic and/or degenerative bony changes. Therefore, the aim of this cadaveric investigation was to demonstrate the feasibility of the ultrasound-guided (USG) injection of the ankle joint via the anterolateral sulcus (ALS) by confirming the dye placement/distribution inside the articular space. Likewise, the safety of the procedure has also been evaluated by measuring the distance between the needle and the intermediate dorsal cutaneous nerve of the foot. DESIGN: A descriptive laboratory study with eight embalmed cadaveric ankles using the Fix for Life (F4L) method was performed at the setting of an academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced into the TT joint through the ALS under US guidance, i.e., in-plane anterior-to-posterior approach. With the objective to confirm its correct placement, the needle was kept in situ and-to demonstrate the location of the dye inside the articular space-all eight ankles were injected with 3 mL of green color dye. Thereafter, a layer-by-layer anatomical dissection was performed on all four cadavers. RESULTS: The position of the needle's tip within the ALS was confirmed in all specimens. Accurate placement of the dye inside the articular space of the ankle was confirmed in seven of the eight cadaveric ankles, with 87.5% of accuracy. Herewith, unintentional spilling of the dye within the superficial soft tissues was reported in two of the eight ankles (25.0%). The mean distance between the needle and the intermediate dorsal cutaneous nerve of the foot, measured in all eight procedures, was 3 cm. CONCLUSION: USG injection of the ALS using the in-plane, anterior-to-posterior approach can accurately place the injectate inside the articular space. CLINICAL RELEVANCE: This cadaveric investigation described the accuracy and potential pitfalls of USG injection of the ankle via the anterolateral approach which represents an alternative technique in patients with reduced accessibility of the anteromedial recess due to degenerative and/or post-traumatic bony changes.

Significance of Physical Exercise in Pregnancy: Comparison of Short and Long Exercise Programs.

BACKGROUND: Several musculoskeletal changes occur in pregnancy, particularly in the abdominal region. The aim of this study was to search and compare the effects of long (LEP) and short exercise programs (SEP) in terms of the satisfaction of the needs of pregnant women. METHODS: This study consisted of 2 groups: LEP (n=16) and SEP (n=16). Muscle thickness measurements determined by ultrasound, the 6 minute walk test, Pregnancy Physical Activity Questionnaire, Visual Analogue Scale, Oswestry Disability Index, and Short Form-36 Quality of Life Questionnaire were the study variables. Evaluations were done at the 16th (baseline), 24th, and 32nd gestational weeks. The LEP consisted of 20 and the SEP consisted of 9 exercises, which were applied for 16 weeks until the 32nd gestational week. RESULTS: Emotional role limitation and pain scores of quality of life, 6 minute walk test, and occupational physical activity were found to be better in the LEP group at the 24th gestational week (p=0.043, p=0.049, p=0.049, p=0.026). At the 32nd gestational week, the 6 minute walk test and occupational physical activity were found to be higher in the LEP group (p=0.006, p=0.017). Additionally, rectus abdominis and bilateral diaphragm muscle thicknesses, "moderate intensity and sports physical activity" and "vitality and emotional well-being" were increased over time with the LEP (p+<+0.05 for all). On the other hand, unilateral diaphragm muscle thickness, sports physical activity level, and vitality were improved with the SEP (p+<+0.05 for all). CONCLUSIONS: The SEP and LEP both have beneficial effects in pregnant women. However, the LEP increases physical activity level, functional capacity, and quality of life more than the SEP during the later stages of pregnancy.

Ultrasound-guided injection of the achilles paratenon: A cadaveric investigation.

BACKGROUND: Injections around the Achilles tendon (AT) are commonly performed in clinical practice to manage non-insertional Achilles tendinopathy, but the presence/distribution of the injectate with relation to its sheath has not been assessed specifically. Accordingly, the aim of this cadaveric investigation was to demonstrate the feasibility of Achilles paratenon injection under ultrasound guidance - by confirming the exact needle positioning as well as the dye distribution inside the paratenon lumen. METHODS: A descriptive laboratory study with three human cadaveric specimens (one fresh cadaver and two cadavers embalmed using the Fix for Life (F4L) method) was performed in a tertiary-care academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced inside the Achilles paratenon under ultrasound guidance i.e. in-plane medial-to-lateral approach. With the objective to confirm its correct placement, the needle was kept in situ on the right AT of the fresh cadaver. Likewise, to demonstrate the location of the dye inside the lumen of Achilles paratenon, the other five ATs - four on the embalmed cadavers and one on the fresh cadaver - were injected with 5 mL of green color dye. After removal of the needle, a layer-by-layer anatomical dissection was performed on all three cadavers. RESULTS: On the right AT of the fresh cadaver, the position of the needle's tip within the Achilles paratenon was confirmed. Accurate placement of the dye inside the paratenon lumen was confirmed in four (80%) ATs, one of the fresh and three of the embalmed cadavers. No spread inside the crural fascia compartment or between the AT and the Kager's fat pad was observed. Herewith, unintentional spilling of the dye within the superficial soft tissues of the posterior leg was reported in the left AT of one of the two embalmed cadavers (20%). CONCLUSIONS: Ultrasound-guided injection using the in-plane, medial-to-lateral approach can accurately target the lumen of Achilles paratenon.

The relationship between sarcopenia-related measurements and osteoporosis: The SARCOP study.

As muscle and bone are closely-related, we have explored the association between sarcopenia-related measurements and bone mineral density (BMD) (and osteoporosis) in postmenopausal women. Grip strength, anterior thigh muscle thickness and chair stand test were found to be related with BMD. Additionally, grip strength < 22 kg increased the odds ratio of osteoporosis 1.6 times. INTRODUCTION: As muscle and bone are two closely related tissues, we aimed to investigate the association between sarcopenia-related measurements (i.e., sonographic anterior thigh muscle thickness, grip strength, chair stand test (CST), gait speed) and clinical factors, lumbar/femoral BMD, and the presence of osteoporosis (OP) in postmenopausal women. METHODS: Community dwelling postmenopausal women from two physical and rehabilitation medicine outpatient clinics were consecutively included in this cross-sectional study. Demographic data, age, weight, height, education/exercise status, smoking, and comorbidities were registered. BMD measurements were performed from lumbar vertebrae (L1-4) and femoral neck using dual energy X-ray absorptiometry (DXA). A T-score of ≤ -2.5 SD in the lumbar vertebrae (L1-L4) and/or femoral neck was accepted as OP. Anterior thigh muscle thickness (MT) at the midthigh level was measured sonographically using a linear probe. Grip strength was measured from the dominant side. Physical performance was assessed by CST and gait speed. RESULTS: Among 546 postmenopausal women, 222 (40.7%) had OP. Among sarcopenia-related parameters, grip strength and anterior thigh MT were positively associated with lumbar vertebral BMD. CST performance was positively associated with femoral neck BMD. After adjusting for confounding factors, low grip strength (< 22 kg) increased 1.6 times the risk of OP. CONCLUSION: Loss of muscle mass/function (i.e., sarcopenia) can coexist with loss of trabecular and cortical bone. To this end, grip strength and anterior thigh MT seem to be associated with the lumbar vertebral BMD, while CST is associated with the femoral neck BMD. Lastly, low grip strength might have an association with postmenopausal OP.

Subacromial Motion Metrics in Painful Shoulder Impingement: A Dynamic Quantitative Ultrasonography Analysis.

OBJECTIVES: To explore the subacromial motion metrics in patients with and without subacromial impingement syndrome (SIS) and to investigate whether the abnormality was associated with rotator cuff pathologies. DESIGN: This cross-sectional observational study used dynamic quantitative ultrasonography imaging for shoulder joint assessment. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Individuals with SIS on at least 1 shoulder (n=32) and asymptomatic controls (n=32) (N=64). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Frame-by-frame, the humeral greater tuberosity against the lateral edge of the acromion was traced to obtain the minimal vertical acromiohumeral distance (AHD). The rotation angle and radius of the humerus were computed using the least-squares curve fitting method. RESULTS: Approximately two-thirds of the shoulders with SIS did not have any sonographically identifiable rotator cuff pathologies. There was a consistent trend of nonsignificantly increased humeral rotation angles in painful shoulders. The generalized estimating equation demonstrated that the decreased minimal vertical AHD was associated with painful subacromial impingement (ß coefficient: -0.123cm, 95% confidence interval [CI], -0.199 to -0.047). The area under the curve for the minimal vertical AHD to discriminate painful or impinged shoulders ranged from 0.624-0.676. The increased rotation angle (ß coefficient: 10.516°; 95% CI, 3.103-17.929) and decreased rotation radius (ß coefficient: -2.903cm; 95% CI, -5.693 to -0.111) were shown to be significantly related to the presence of supraspinatus tendinopathy. CONCLUSIONS: Shoulders with SIS were characterized by a decreased minimal vertical AHD during dynamic examination. Abnormal subacromial metrics can develop in patients with mild (or no) rotator cuff pathologies. More prospective cohort studies are warranted to investigate the changes in subacromial motion metrics in populations at risk for painful or impinged shoulders.

BOBATH vs. TASK-ORIENTED TRAINING AFTER STROKE: An assessor-blind randomized controlled trial.

OBJECTIVES: To evaluate/compare the effects of the Bobath concept and task-oriented training on motor function, muscle thickness, balance, gait, and perception of goal achievement in patients with stroke. METHODS: Thirty-two patients were randomly divided into Bobath and task-oriented groups. Exercises were applied for one hour a day, three days a week, for eight weeks. Clinical (Trunk Impairment Scale (TIS), Stroke Rehabilitation Assessment of Movement (STREAM), Goal Attainment Scale (GAS), balance, gait)) and trunk muscle thickness assessments (with ultrasound) were performed. RESULTS: Thirty patients completed the study. TIS, STREAM, and GAS scores were increased in both groups (all p < 0.05). Bilateral rectus abdominis thickness was found to have increased in the Bobath group whereby this increase was better when compared with the task-oriented group (p < 0.05). The limits of stability increased in both groups (p < 0.05). Postural sway was decreased in the anteroposterior (normal stability eyes open) in the Bobath group and the anteroposterior (perturbated stability eyes closed) in the task-oriented group. Velocity, step length, and functional ambulation profile scores increased, and double support of the paretic side decreased in the task-oriented group (all p < 0.05). CONCLUSIONS: The Bobath concept appears to be superior to task-oriented training in increasing the thickness of rectus abdominis in patients with stroke. Although the task-oriented training provided significant improvement, especially in terms of gait, no superiority was found between the two rehabilitation approaches in terms of functional ability.

The chronicle of headache treatment throughout human history from trepanation to perisutural botulinum toxin injections.

To provide a historic snapshot as regards the evolution of headache treatment throughout the human history, i.e. starting from trepanation to perisutural botulinum toxin (BoNT) injections. Ancient surgeons had aimed to reach the cranium with trepanation (a surgical operation) for headache. As BoNT inhibits the release of nociceptive and pro-inflammatory neuropeptides, it has been recently suggested as an effective alternative in the prophylactic treatment of chronic migraine headache. Chronic migraine is a complex neurological disorder for which the underlying pathophysiology is yet not totally explained. According to the generally accepted hypotheses, peripheral neurogenic activation and central trigeminal sensitization are the two main mechanisms through which its pain develops. Since the headache most commonly occurs around the perisutural areas, and as the primary pathogenesis stem from the meningeal nerve fibers; collateral sensorial branches of the meningeal nerves can be optimal paths to transport BoNT inside the cranium. Concerning the therapeutic efficacy, we anticipate that perisutural injections would be technically challenging with blind techniques and actually possible only if performed under an imaging guidance, e.g. very conveniently with high frequency ultrasound.

Hearing and Seeing Nerve/Tendon Snapping: A Systematic Review on Dynamic Ultrasound Examination.

Nerve/tendon snapping can occur due to their sudden displacement during the movement of an adjacent joint, and the clinical condition can really be painful. It can actually be challenging to determine the specific anatomic structure causing the snapping in various body regions. In this sense, ultrasound examination, with all its advantages (especially providing dynamic imaging), appears to be quite promising. To date, there are no comprehensive reviews reporting on the use of dynamic ultrasound examination in the diagnosis of nerve/tendon snapping. Accordingly, this article aims to provide a substantial discussion as to how US examination would contribute to 'seeing' and 'hearing' these pathologies' different maneuvers/movements.

Low back pain, ultrasonographic muscle thickness measurements and biopsychosocial factors at different trimesters of pregnancy.

BACKGROUND: Pregnancy-related low back pain is a multifactorial problem and its assosiation with pain intensity and biopsycosocial factors can not be fully explained. This study aimed to determine the psychosocial as well as biological/physical risk factors associated with self-reported low back pain (LBP) intensity during different trimesters of pregnancy. METHODS: This cross-sectional study comprised 107 pregnant women. An introductory information form for physical and medical characteristics, Visual Analog Scale (VAS) for low back pain intensity and Oswestry Disability Index (ODI) for degree of loss of functionality, Short Form-36 (SF-36) for quality of life and Pregnancy Physical Activity Questionnaire (PPAQ) for physical activity were applied. Abdominal muscle thicknesses and diastasis recti were measured by ultrasonography. Univariate regression was used to analyse associations between each plausible independent variable and low back pain intensity. RESULTS: Mean LBP intensity during 1st, 2nd ve 3rd trimesters were 26.8 ± 20.9, 27.3 ± 19.8, 21.6 ± 20.1 mm, respectively. ODI scores were associated with LBP intensity, explaining 11%, 13% and 26% of LBP severity during the 1st, 2nd ve 3rd trimesters, respectively. Other biological/physical variables like age, body mass index, muscle thickness and diastasis recti were not associated with pain intensity. SF-36 emotional role limitation (coef = -0.03, R2 = 0.20, p = 0.01) in the 3rd trimester and SF-36 pain score in the 1st (coef = -0.04, R2 = 0.12, p = 0.02) and 3rd (coef = -0.05, R2 = 0.26, p = 0.004) trimesters and PPAQ-sedentary was associated during the 2nd trimester (coef = 0.17, R2 = 0.17, p = 0.02) with pain intensity. CONCLUSION: ODI scores were associated with LBP intensity in all three trimesters, with SF-36 pain domain in the 1st and 3rd trimesters, with SF-36 emotional role limitation only in the 3rd trimester and with sedentary activity level only in the 2nd trimester. Increased pain intensity was surprisingly associated with a small number of biopsychosocial factors in all the trimesters. There is need for further large-sample studies.

The effect of aerobic training on motor function and muscle architecture in children with Duchenne muscular dystrophy: A randomized controlled study.

OBJECTIVE: To explore the effects of aerobic training adding to home-based exercise program on motor function and muscle architectural properties in children with Duchenne muscular dystrophy. DESIGN: This is a prospective randomized controlled study. SETTING: Pediatric neuromuscular clinic in a tertiary care center. SUBJECTS: Children with Duchenne muscular dystrophy. INTERVENTIONS: Children were randomly divided into two groups whereby 12-weeks aerobic training was additionally given in treatment group in contrast to the control group which received only home-based exercise program. MAIN MEASURES: Motor Function Measure and Six Minute Walk Test were used for clinical evaluation, and muscle architectural properties (thickness, pennation angle and fascicle length) were measured by ultrasound imaging. Both groups were assessed at baseline and after 12-weeks of training. RESULTS: Median age of children was 7.9 years in the treatment group and 8.6 years in the control group (p > 0.05). Significant improvements were obtained for Motor Function Measure and Six Minute Walk Test from baseline to 12-weeks in the treatment group; Motor Function Measure total score changed from 83.2 (6.1) to 86.9 (4.0) vs. 82.3 (10.2) to 80.4 (9.4) points in the control group (p = 0.006); 6 Minute Walk Test distance changed from 395.3 (46.6) to 413.0 (52.3) vs. 421.7 (64.4) to 393.8 (68.2) meters in the control group (p < 0.001). However, muscle architectural parameters did not change during study period (p > 0.05). CONCLUSION: Aerobic training may be of additional value in improving motor function and performance with no remarkable effect on muscle architectural properties.

Assessing/Imaging the Subcoracoid Space: From Anatomy to Dynamic Sonography.

In the pertinent literature, standardized sonographic protocols have been widely described to evaluate the different compartments of the shoulder. However, the subcoracoid space is a complex anatomical region-usually not included/described in basic ultrasound approaches. Accordingly, starting from its anatomy, we describe a two-phase dynamic ultrasound protocol to scan the subcoracoid space. This way, we aim to optimize the diagnosis and management of patients with anterior shoulder pain and subcoracoid effusion.

Homing in on cognition with cross-sectional analysis of sarcopenia-related measurements: the SARCOG study.

BACKGROUND: Cognitive impairment may cause significant decline in muscle function and physical performance via affecting the neuromotor control. AIM: To investigate the relationship between cognition and sarcopenia-related parameters in middle-aged and older adults. METHODS: Demographic data and comorbidities of adults ≥ 45-year-old were noted. The Mini-Mental State Examination (MMSE) was used to evaluate global cognitive function. Sonographic anterior midthigh muscle thickness, handgrip strength, chair stand test (CST) and gait speed were measured. The diagnosis of sarcopenia was established if low muscle mass was combined with low muscle function. Dynapenia was defined as low grip strength or increased CST duration. RESULTS: Among 1542 subjects (477 M, 1065 F), sarcopenia and dynapenia were detected in 22.6 and 17.2% of males, and 17.2 and 25.3% of females, respectively. Sarcopenic patients were older and had higher body mass index, higher frequencies of hypertension, diabetes mellitus and obesity. They had lower muscle thickness, grip strength in males only, CST performance in females only and gait speed than the other groups (all p < 0.05). Sarcopenic and dynapenic patients had similar MMSE scores which were lower than those of normal subjects (both p < 0.001). After adjusting for confounding factors, MMSE values were positively related with grip strength in females only, CST performance and gait speed (all p < 0.001); but not with muscle thickness in either gender. CONCLUSION: Cognitive impairment may unfavorably affect muscle function and physical performance, but not muscle mass. Accordingly, its prompt management can help to decrease patient morbidity and mortality.

The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies.

The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.