Effect of M-wave Amplitude on Inter-evaluator Concordance and Number of Detected Innervation Zones in the Medial Gastrocnemius Using Multichannel Electromyography / Efecto de la Amplitud de la Onda M sobre la Concordancia entre Evaluadores y el Número de Zonas de Inervación Detectadas en el Gastrocnemio Medial Mediante Electromiografía Multicanal

SUMMARY: The Innervation Zones (IZ) correspond to clusters of neuromuscular junctions. The traditional method of locating IZs through voluntary muscle contractions may not be feasible in individuals with motor disorders. Imposed contractions by electrostimulation are an alternative. However, there is limited evidence regarding the factors that affect inter-evaluator concordance and the number of localized IZs when using imposed contraction. The main objective of this research was to determine the effect of the amplitude of compound motor action potentials (CMAPs) containing the M-wave on inter-evaluator agreement. As a secondary objective, was investigate the effect on the number of detected IZs. Twenty-four healthy volunteers (age: 21.2 ± 1.5years, weight: 67.4 ± 13.2kg, height: 1.68 ± 0.80m) participated in the study. Electrostimulation was applied to the tibial nerve to induce contraction of the medial gastrocnemius. The IZ were identified based on the M-wave recorded through multichannel electromyography. A receiver operating characteristic (ROC) analysis was conducted to assess sensitivity and specificity in detecting the IZs. Inter-rater agreement was evaluated using a two-way mixed effects test to determine the intraclass correlation coefficients (ICC). A p-value less than 0.05 was considered statistically significant. The ROC analysis revealed that for both evaluators, a specificity of 95% was achieved with an amplitude ≥30 %. The area under the ROC curve was 0.980 [0.964, 0.996], indicating a strong influence of CMAP amplitude on detection of IZs. The highest level of agreement (ICC = 0.788 [0.713, 0.844]) among the evaluators was observed with CMAP amplitudes equal to or greater than 80 % of the maximum M-wave. The findings of this study demonstrate that both the number and the inter-evaluator concordance for detecting IZs using imposed contractions are strongly influenced by the amplitude of the M-wave. Higher M-wave amplitudes were associated with improved concordance and increased IZ detection, making it crucial to standardize amplitude settings for reliable outcomes.

Las Zonas de Inervación (IZ) corresponden a grupos de uniones neuromusculares. El método tradicional para localizar IZs mediante contracciones musculares voluntarias puede no ser factible en personas con trastornos motores. Las contracciones impuestas mediante electro estimulación son una alternativa. Sin embargo, existe poca evidencia sobre los factores que afectan la concordancia entre evaluadores y el número de IZs localizadas al usar este tipo de contracciones. El objetivo de esta investigación fue determinar el efecto de la amplitud de los potenciales de acción motores compuestos (PAMCs) que contienen la onda M sobre la concordancia entre evaluadores. Como objetivo secundario, se investigó el efecto sobre el número de IZs detectadas. Veinticuatro voluntarios sanos (edad: 21.2 ± 1.5 años, peso: 67.4 ± 13.2 kg, altura: 1.68 ± 0.80 m) participaron en el estudio. Se aplicó electroestimulación al nervio tibial para inducir la contracción del gastrocnemio medial. Las IZs se identificaron según la onda M registrada mediante electromiografía multicanal. Se realizó un análisis de curva de las característica del receptor (ROC) para evaluar la sensibilidad y especificidad en la detección de las IZs. La concordancia entre evaluadores se evaluó utilizando una prueba de efectos mixtos de dos vías para determinar los coeficientes de correlación intraclase (ICC). Se consideró un valor de p menor que 0.05 como estadísticamente significativo. El análisis ROC reveló que para ambos evaluadores se logró una especificidad del 95% con una amplitud ≥30 %. El área bajo la curva ROC fue de 0.980 [0.964, 0.996], lo que indica una fuerte influencia de la amplitud del CMAP en la detección de las IZs. El nivel más alto de concordancia (ICC = 0.788 [0.713, 0.844]) entre los evaluadores se observó con amplitudes de CMAP iguales o mayores al 80 % de la onda M máxima. Los hallazgos de este estudio demuestran que tanto el número como la concordancia entre evaluadores para detectar IZs mediante contracciones impuestas están fuertemente influenciados por la amplitud de la onda M. Las amplitudes más altas de la onda M se asociaron con una concordancia mejorada y un aumento en la detección de IZs, lo que hace crucial estandarizar los ajustes de amplitud para obtener resultados confiables.

Triceps surae elasticity modulus measured by shear wave elastography is not correlated to the plantar flexion torque.

BACKGROUND: Supersonic Shear Imaging (SSI) is a technique which analyses quantitatively the tissue properties in real time. The relation between joint torque and Young's modulus (E) of the agonist muscles is important for obtaining stratification values and ranges of normality. The aim of this study was to evaluate the intra and intersessions reliability of the E values of the Achilles tendon and medial gastrocnemius muscle, bilaterally, during rest, and correlate them with the isometric plantarflexion peak torque. METHODS: Shear modulus maps were acquired bilaterally in Achilles tendon (AT) and medial gastrocnemius (MG) muscle of 24 healthy male volunteers. Two 5-second plantarflexion maximal voluntary contractions were performed with a 40-seconds interval and correlated with E values. RESULTS: a good intrasession reliability (intraclass correlation coefficient- ICC= 0.821-0.986) and a weak Pearson's correlation was found between E values and peak torque (r= 0.022 to -0.202) for both limbs (P > .05). CONCLUSION: E values cannot be predictive of the triceps surae force production in untrained men. It could be helpful, otherwise, to monitor a chronic strength adaptation after an exercise intervention or rehabilitation program. LEVEL OF EVIDENCE: IIb, individual cohort study.

The importance of cutaneous feedback on neural activation during maximal voluntary contraction.

PURPOSE: The purpose of this study was to investigate the importance of cutaneous feedback on neural activation during maximal voluntary contraction (MVC) of the ankle plantar flexors. METHODS: The effects of cutaneous plantar anaesthesia were assessed in 15 subjects and compared to 15 controls, using a one-day pre/post-repeated measures design. Cutaneous plantar anaesthesia was induced by lidocaine injection at the centre of forefoot, lateral midfoot, and heel. Each subject performed isometric MVCs of the ankle plantar flexors. During each isometric ramp contraction, the following variables were assessed: maximal isometric torque; surface electromyography (EMG) activity of the medial gastrocnemius (MG) and tibialis anterior (TA) muscles; and co-contraction index (CCI) between the MG and TA. RESULTS: For ankle torque, two-way ANOVA showed no significant interaction between the pre/post-measurements × group (p = 0.166). However, MG activity presented significant interactions between the pre/post-measurements × group (p = 0.014). Post hoc comparisons indicated a decrease of MG activity in the experimental group, from 85.9 ± 11.9 to 62.7 ± 30.8% (p = 0.016). Additionally, the post-anaesthesia MG activity of the experimental group differed statistically with pre- and post-MG activity of the control group (p = 0.027 and p = 0.008, respectively). For TA activity and CCI, two-way ANOVA detected no significant interactions between the pre/post-measurements × group (p = 0.605 and p = 0.332, respectively). CONCLUSION: Our results indicate that during MVC, cutaneous feedback modulates neural activity to MG muscle, without changing the extent of MG-TA co-contraction.

Agenesis of the medial gastrocnemius and plantar muscle: case presentation / Agenesia del gastrocnemio medial y del músculo plantar: presentación de caso

We present the case of a left medial gastrocnemius and plantar muscle agenesis in a 58-years old male cadaveric specimen from the Anatomy Laboratory at the Universidad Industrial de Santander (Bucaramanga-Colombia). These unusual muscle absences and associated functional alterations, enrich anatomical knowledge and become important by the time the affected individual may need a reconstructive procedure.

Se presenta un caso de agenesia de los músculos gastrocnemio medial y plantar izquierdos en un espécimen cadavérico masculino de 58 años, del laboratorio de anatomía de la Universidad Industrial de Santander (Bucaramanga- Colombia). Estas raras ausencias musculares enriquecen el conocimiento anatómico con sus alteraciones funcionales concomitantes y permiten postular los posibles procedimientos reconstructivos requeridos en los individuos que las presentan.