Closed chain assessment of quadriceps activation using the superimposed burst technique

The superimposed burst technique is used to estimate quadriceps central activation ratio during a maximal voluntary isometric contraction, which is calculated from force data during an open-chain knee extension task. Assessing quadriceps activation in a closed-chain position would more closely simulate the action of the quadriceps during activity. Our aim was to determine the test–retest reliability of the quadriceps central activation ratio in the closed chain.MethodsTwenty-two healthy, active volunteers (13M/12F; age = 23.8 ± 3; height = 72.7 ± 14.5 cm; mass = 175.3 ± 9.6 kg) were recruited to participate. Knee extension MVIC torque and the peak torque during a superimposed electrical stimulus delivered to the quadriceps during an MVIC were measured to estimate quadriceps CAR. Interclass correlation coefficients were used to assess test–retest reliability between sessions, and Bland–Altman plots to graphically assess agreement between sessions.ResultsTest–retest reliability was fair for CAR (ICC_2,k = 0.68; P = 0.005), with a mean difference of −2.8 ± 10.3%, and limits of agreement ranging −23.1–18.1%.ConclusionsCAR calculated using the superimposed burst technique is moderately reliable in a closed-chain position using technique-based instruction. Although acceptable reliability was demonstrated, wide limits of agreement suggest high variability between sessions.     

Measurement of waist circumference for retrospective studies – Prospective validation of use of CT images to assess abdominal circumference

IntroductionTo validate the use of supine position and CT images for assessing abdominal circumference (AC).MethodA prospective study in consecutive patients undergoing scheduled abdominal CT at our center between 17 and 25 September 2012.AC was measured four times:

• 1.Standing.
• 2.While lying on the CT table.
• 3.On CT images with a skin contour line, using OsiriX software.
• 4.On CT images with an ellipse perimeter formula, using RAIM Alma 2010 software.

Measurements 1 and 2 were sequentially done by the same trained nurse before abdominal CT just above the iliac crest, while measurements 3 and 4 were done on the last abdominal CT slice not showing the iliac bone. Student's t tests and Q-Q and Bland–Altman plots were used for statistical analysis.ResultsA total of 102 patients were recruited. Mean age, 60 (35–78) years. Mean BMI, 25 (18–39) kg/m². Mean AC, 93.2 (73–135) cm.No significant differences were found between the four ACs measured (Student's t test, P = 0.83).Q-Q and Bland–Altman plots showed good overlapping for the low and central values (73–110 cm) with a greater scatter for extremely high values.For the ellipse estimation, R² was 0.987 with a mean error of 0.4 cm and a stretch dispersion between 1.1 and −0.3 cm.ConclusionSupine (either measured or estimated on CT images by free hand elliptical ROI or ellipse formula) and standing measurements appear to be equivalent for abdominal circumferences <110 cm.     

Measurement of clavicular length and shortening after a midshaft clavicular fracture: Spatial digitization versus planar roentgen photogrammetry

Purpose: Clavicular shortening after fracture is deemed prognostic for clinical outcome and is therefore generally assessed on radiographs. It is used for clinical decision making regarding operative or non-operative treatment in the first 2 weeks after trauma, although the reliability and accuracy of the measurements are unclear. This study aimed to assess the reliability of roentgen photogrammetry (2D) of clavicular length and shortening, and to compare these with 3D-spatial digitization measurements, obtained with an electromagnetic recording system (Flock of Birds). Patients and methods: Thirty-two participants with a consolidated non-operatively treated two or multi-fragmented dislocated midshaft clavicular fracture were analysed. Two observers measured clavicular lengths and absolute and proportional clavicular shortening on radiographs taken before and after fracture consolidation. The clavicular lengths were also measured with spatial digitization. Inter-observer agreement on the radiographic measurements was assessed using the Intraclass Correlation Coefficient (ICC). Agreement between the radiographic and spatial digitization measurements was assessed using a Bland–Altman plot. Results: The inter-observer agreement on clavicular length, and absolute and proportional shortening on trauma radiographs was almost perfect (ICC > 0.90), but moderate for absolute shortening after consolidation (ICC = 0.45). The Bland–Altman plot compared measurements of length on AP panorama radiographs with spatial digitization and showed that planar roentgen photogrammetry resulted in up to 37 mm longer and 34 mm shorter measurements than spatial digitization. Conclusion: Measurements of clavicular length on radiographs are highly reliable between observers, but may not reflect the actual length and shortening of the clavicle when compared to length measurements with spatial digitization. We recommend to use proportional shortening when measuring clavicular length or shortening on radiographs for clinical decision making.     

Correlation between semitendinosus and gracilis tendon cross-sectional area determined using ultrasound,magnetic resonance imaging and intraoperative tendon measurements

The purpose of this study was to examine the correlation in semitendinosus (ST) and gracilis (GT) tendon cross-sectional area (CSA) evaluated directly during anterior cruciate ligament (ACL) surgery and pre-operatively using ultrasound (US) and magnetic resonance imaging (MRI). A total of 14 patients undergoing ACL reconstruction with a quadruple ST–GT graft by the same orthopaedic surgeon participated in this study. Pre-operative evaluation included determination of ST and GT CSA area using US and MRI. Intraoperative measurement of the diameters of the ST, GT and the final ACL graft using a closed-hole sizing block with 0.5-mm increments was made and this diameter was used to estimate tendon CSA. The correlation between graft diameter and CSA were 0.563 (GT) and 0.807 (ST) for MRI and 0.498 (GT) and 0.612 (ST) for US. The final ACL graft diameter displayed a correlation coefficient of 0.813 with MRI CSA and 0.518 with US CSA. No differences in CSA were observed between intraoperative, MRI and US methods (p > 0.05). The intraclass correlation coefficients between the US, MRI and intraoperative graft methods for the ST and GT data ranged from 0.502 to 0.903 with an estimation error ranging from 1.41% to 2.26%. These results indicate that in clinical situations where MRI is contra-indicated or not accessible, US can provide measurable values which could predict sufficient diameter of the ACL graft. In addition, determination of tendon CSA using US displays errors less than 2% which is similar to that observed using MRI. This suggests that the application of US can be applied to in vivo examination of the ST and GT CSA.     

Acute effect of heel-drop exercise with varying ranges of motion on the gastrocnemius aponeurosis-tendon’s mechanical properties

The objectives of this study was to investigate the acute effects of various magnitudes of tendon strain on the mechanical properties of the human medial gastrocnemius (MG) in vivo during controlled heel-drop exercises. Seven male and seven female volunteers performed two different exercises executed one month apart: one was a heel-drop exercise on a block (HDB), and the other was a heel-drop exercise on level floor (HDL). In each regimen, the subjects completed a session of 150 heel-drop exercises (15 repetitions × 10 sets; with a 30 s rest following each set). Before and immediately after the heel-drop exercise, the ankle plantar flexor torque and elongation of the MG were measured using a combined measurement system of dynamometry and ultrasonography and then the MG tendon strain and stiffness were evaluated in each subject. The tendon stiffness measured prior to the exercises was not significantly different between the two groups 23.7 ± 10.6 N/mm and 24.1 ± 10.0 N/mm for the HDB and HDL, respectively (p > .05). During the heel-drop exercise, it was found that the tendon strain during the heel-drop exercise on a block (8.4 ± 3.7%) was significantly higher than the strain measured on the level floor (5.4 ± 3.8%) (p < .05). In addition, the tendon stiffness following the heel-drop exercise on a block (32.3 ± 12.2 N/mm) was significantly greater than the tendon stiffness measured following the heel-drop exercise on the level floor (25.4 ± 11.4 N/mm) (p < .05). The results of this study suggest that tendon stiffness immediately following a heel-drop exercise depends on the magnitude of tendon strain.     

Mechanical properties of the patellar tendon in adults and children

It is not currently known how the mechanical properties of human tendons change with maturation in the two sexes. To address this, the stiffness and Young's modulus of the patellar tendon were measured in men, women, boys and girls (each group, n=10). Patellar tendon force (F_pt) was calculated from the measured joint moment during a ramped voluntary isometric knee extension contraction, the antagonist knee extensor muscle co-activation quantified from its electromyographical activity, and the patellar tendon moment arm measured from magnetic resonance images. Tendon elongation was imaged using the sagittal-plane ultrasound scans throughout the contraction. Tendon cross-sectional area was measured at rest from ultrasound scans in the transverse plane. Maximal F_pt and tendon elongation were (mean±SE) 5453±307 N and 5±0.5 mm for men, 3877±307 N and 4.9±0.6 mm for women, 2017±170 N and 6.2±0.5 mm for boys and 2169±182 N and 5.9±0.7 mm for girls. In all groups, tendon stiffness and Young's modulus were examined at the level that corresponded to the maximal 30% of the weakest participant's F_pt and stress, respectively; these were 925–1321 N and 11.5–16.5 MPa, respectively. Stiffness was 94% greater in men than boys and 84% greater in women than girls (p<0.01), with no differences between men and women, or boys and girls (men 1076±87 N/mm; women 1030±139 N/mm; boys 555±71 N/mm and girls 561.5±57.4 N/mm). Young's modulus was 99% greater in men than boys (p<0.01), and 66% greater in women than girls (p<0.05). There were no differences in modulus between men and women, or boys and girls (men 597±49 MPa; women 549±70 MPa; boys 255±42 MPa and girls 302±33 MPa). These findings indicate that the mechanical stiffness of tendon increases with maturation due to an increased Young's modulus and, in females due to a greater increase in tendon cross-sectional area than tendon length.     

Two novel methods to assess ulnar nerve conduction across the elbow

PurposeNerve conduction studies (NCS) are used as an electrodiagnostic method for diagnosing ulnar neuropathy of the elbow (UNE). The purpose of this study was to determine normal and reliability values of across elbow ulnar nerve conduction velocity using two novel methods.MethodsUlnar nerve conduction studies were performed on both upper extremities of 104 healthy subjects. Two different techniques were used to evaluate ulnar nerve function at the elbow: Technique 1 (W-BE-AE) determined mixed NCV across the elbow indirectly while Technique 2 (BE-AE) measured conduction time directly. Twenty subjects returned within one week for re-testing to generate reliability data.ResultsThe mean NCV for the BE-AE segment using Technique 1 was 59.68 m/s (±8.91 m/s). The mean peak latency for the BE-AE segment using Technique 2 was 2.03 ms (±0.24 ms). The interrater and intrarater reliability intraclass correlation coefficient (ICC) for Technique 1 was 0.454 and 0.756, respectively. For Technique 2, the interrater and intrarater reliability ICC was 0.76 and 0.814, respectively.ConclusionThis study identified normal values for ulnar nerve conduction across the elbow with reliability ranging from poor to good, depending on the technique. These two novel techniques provide alternative methods to traditional techniques to measure ulnar nerve conduction across the elbow.     

Changes in tendon spatial frequency parameters with loading

To examine and compare the loading related changes in micro-morphology of the patellar tendon.Fifteen healthy young males (age 19 ± 3 yrs, body mass 83 ± 5 kg) were utilised in a within subjects matched pairs design. B mode ultrasound images were taken in the sagittal plane of the patellar tendon at rest with the knee at 90° flexion. Repeat images were taken whilst the subjects were carrying out maximal voluntary isometric contractions.Spatial frequency parameters related to the tendon morphology were determined within regions of interest (ROI) from the B mode images at rest and during isometric contractions.A number of spatial parameters were observed to be significantly different between resting and contracted images (Peak spatial frequency radius (PSFR), axis ratio, spatial Q-factor, PSFR amplitude ratio, and the sum). These spatial frequency parameters were indicative of acute alterations in the tendon micro-morphology with loading.Acute loading modifies the micro-morphology of the tendon, as observed via spatial frequency analysis. Further research is warranted to explore its utility with regard to different loading induced micro-morphological alterations, as these could give valuable insight not only to aid strengthening of this tissue but also optimization of recovery from injury and treatment of conditions such as tendinopathies.     

Plasticity of human Achilles tendon mechanical and morphological properties in response to cyclic strain

The purpose of the current study in combination with our previous published data (Arampatzis et al., 2007) was to examine the effects of a controlled modulation of strain magnitude and strain frequency applied to the Achilles tendon on the plasticity of tendon mechanical and morphological properties. Eleven male adults (23.9±2.2 yr) participated in the study. The participants exercised one leg at low magnitude tendon strain (2.97±0.47%), and the other leg at high tendon strain magnitude (4.72±1.08%) of similar frequency (0.5 Hz, 1 s loading, 1 s relaxation) and exercise volume (integral of the plantar flexion moment over time) for 14 weeks, 4 days per week, 5 sets per session. The exercise volume was similar to the intervention of our earlier study (0.17 Hz frequency; 3 s loading, 3 s relaxation) allowing a direct comparison of the results. Before and after the intervention ankle joint moment has been measured by a dynamometer, tendon–aponeurosis elongation by ultrasound and cross-sectional area of the Achilles tendon by magnet resonance images (MRI). We found a decrease in strain at a given tendon force, an increase in tendon–aponeurosis stiffness and tendon elastic modulus of the Achilles tendon only in the leg exercised at high strain magnitude. The cross-sectional area (CSA) of the Achilles tendon did not show any statistically significant (P>0.05) differences to the pre-exercise values in both legs. The results indicate a superior improvement in tendon properties (stiffness, elastic modulus and CSA) at the low frequency (0.17 Hz) compared to the high strain frequency (0.5 Hz) protocol. These findings provide evidence that the strain magnitude applied to the Achilles tendon should exceed the value, which occurs during habitual activities to trigger adaptational effects and that higher tendon strain duration per contraction leads to superior tendon adaptational responses.     

Late gadolinium enhancement MRI quantification to predict left ventricular remodeling after acute myocardial infarction

ObjectivesInfarct size is a major surrogate marker for prognosis in the context of myocardial infarction. There is a growing interest in validating a quantitative assessment approach in order to: (1) standardize these analyses; (2) to precise the individual prognosis of our patients. Several methods are available and were tested across their capacity to predict left ventricular (LV) remodeling at three months.Patients and methodsLate gadolinium enhancement-MRI was performed on day 5 and after a period of three months in 92 patients with STEMI. LV volumes and scar parameters were assessed visually (by using a four scale score) and quantitatively on day 5 and at three months. Dichotomous thresholds were defined first visually (VISUAL), then by 2, 5 and 6 standard deviations above remote myocardium, and by the full-width at half-maximum (FWHM) method.ResultsAll infarct sizing methods showed great relation to LV remodeling at three months (ROC analysis). Univariate predictors of an LV end-systolic volume index (LVESVi) superior to 70 mL/m² were: heart failure, creatin kinase peak and infarct size at day 5. FWHM was shown to be the best of all quantitative methods. An infarct size superior to 44 grams predicted a LVESVi > 70 mL/m² with a sensitivity of 90% and a specificity of 92.5%. FWHM reproducibility was good (r = 0.895, P < 0.0001, Bland Altman bias of 0.8 g).ConclusionIn the context of STEMI, FWHM is a tough and reproducible algorithm to quantitatively assess late gadolinium hyperenhancement, greatly related to functional prognosis at three months follow-up.     

Concordance of the location of the innervation zone of the tibialis anterior muscle using voluntary and imposed contractions by electrostimulation

Background: The innervation zone (IZ) corresponds to the location of the neuromuscular junctions. Its location can be determined by using arranged surface linear electrode arrays. Typically, voluntary muscle contractions (VC) are used in this method. However, it also may be necessary to locate the IZ under clinical conditions such as spasticity, in which this type of contraction is difficult to perform. Therefore, contractions imposed by electrostimulation (ES) can be an alternative. There is little background comparing the locations of IZ obtained by two different types of contractions. Objective: Evaluate the concordance between using voluntary and imposed contractions from electrostimulation in order to determine the location of the innervation zone of the tibialis anterior muscle in healthy volunteers. Methods: The tibialis anterior (TA) muscle of sixteen volunteers (men: 8; women: 8; age: 22.1 ± 1.4 years, weight: 61.6 ± 7.5 kg, height: 167.1 ± 7.5 cm) were evaluated using a linear electrode array. The IZ of the TA muscle was located using two types of muscle contractions, voluntary (10% MVC) and imposed contractions by ES. The concordance between both conditions was evaluated using the Bland–Altman method and the concordance correlation coefficient (CCC). The analyses were applied to the absolute and relative positions to the length of an anatomical landmark frame. Results: CCC for absolute position was 0.98 (p < 0.0001, 95% CI [0.98–1.00], and CCC for relative positions also was 0.98 (p < 0.0001, 95% CI [0.97–1.00]). The Bland–Altman analysis for absolute data showed an average difference of −0.63 mm (SD: 4.1). Whereas, for adjusted data, the average difference was −0.20% (SD: 1.2). The power of the results, based on absolute data, was 98%, whereas for relative data, 82%. Conclusion: In healthy volunteers, there was a substantially concordance between the location of the IZ of the TA muscle derived from using contractions imposed by ES and the location derived from using VC.     

Electromyographic latency of postural evoked responses from the leg muscles during EquiTest Computerised Dynamic Posturography: Reference data on healthy subjects

No normative data are available for the latencies of the EMG signals from the ankle muscles in response to sudden sagittal tilt (toes-UP or toes-DOWN) or shift (shift-FOR or shift-BACK) of the support surface during standing. In this study the postural evoked response (PER) paradigm on the EquiTest™ force platform was applied to 31 healthy adults (18 women and 13 men; mean age 29 years). The EMG latencies (PEREMG) were computed both through the standard manual procedure and through a specially designed automated algorithm. The manually computed PEREMG onset yielded a 95% tolerance interval between 82 ms and 148 ms after toes-UP perturbation, between 93 ms and 182 ms after toes-DOWN perturbation, between 67 ms and 107 ms after shift-BACK perturbation, and between 73 ms and 113 ms after shift-FOR perturbation. When comparing the two methods, paired t-tests showed no significant mean difference (Bonferroni-adjusted p-values ranged from 0.440 to 1.000) and all Bland–Altman plots included zero difference within the limits of agreement. Therefore, the manual and the automated methods appear to be sufficiently consistent. These results foster the clinical application of PEREMG testing on the EquiTest platform.     

Test–retest reliability of the soleus H-reflex is affected by joint positions and muscle force levels

The purpose of this study was to determine the test–retest reliability of the soleus (SOL) H-reflex during rest and isometric contractions at 10%, 30%, and 50% of the maximal voluntary force (MVC) at the ankle joint angles of neutral (0°), plantarflexion (20°), and dorsiflexion (?20°) respectively, in a sitting position. Ten healthy participants, with mean age of 24.9 ± 5.0 (SD) years, height 168.3 ± 8.8 cm, weight 62.7 ± 12.3 kg, were tested for the SOL H-reflex (H_max) on two separate occasions within 7 days. The intraclass correlation coefficient (ICC) for the test–retest of the SOL H-reflex during rest was found to be high at ankle joint angle of neutral (ICC = 0.92) and plantarflexion (0.96), and moderate at dorsiflexion (0.75). Inconsistent ICC values (range from 0.62 to 0.97) were found during the submaximal voluntary contractions at the three ankle joint positions. High ICCs were also found in H_max/M_max ratio at neutral (0.86), plantarflexion (0.96), and dorsiflexion (0.84) positions. It was concluded that the test–retest reliability of the SOL H-reflex was affected by the intensity of voluntary contraction and ankle joint position. The H-reflex demonstrated a higher reliability at the neutral and plantarflexion positions than that at the dorsiflexion position during rest, and a higher reliability at 10% MVC than that at 30% and 50% MVC.     

The influence of cryopreservation and quick-freezing on the mechanical properties of tendons

In order to maintain their native properties, cryopreserved tendons are usually used in biomechanical research and in transplantation of allogenic tendon grafts. The use of different study protocols leads to controversy in literature and thus complicates the evaluation of the current literature. The aim of this study consisted in examining the influence of different freezing and thawing temperatures on the mechanical properties of tendons. 60 porcine tendons were frozen at either −80 °C or −20 °C for 7 days and thawed at room or body temperature for 240 or 30 min, respectively. A subgroup of ten tendons was quick-frozen with liquid nitrogen (−196 °C) for 2 s before cryopreservation. Biomechanical testing was performed with a material testing machine and included creep, cyclic and load-to-failure tests. The results showed that freezing leads to a reduced creep strain after constant loading and to an increased secant modulus. Freezing temperature of −80 °C increased the secant modulus and decreased the strain at maximum stress, whereas thawing at room temperature reduced the maximum stress, the strain at initial tendon failure and the Young’s Modulus. Quick-freezing led to increased creep strain after constant loading, increased strain at initial failure in the load-to-failure test, and decreased strain at maximum stress. When cryopreserving, tendons for scientific or medical reasons, freezing temperature of −20 °C and thawing temperature of 37.5 °C are recommended to maintain the native properties of tendons. A treatment with liquid nitrogen in the sterilization process of tendon allografts is inadvisable because it alters the tendon properties negatively.     

Body temperature in premature infants during the first week of life: Exploration using infrared thermal imaging

BackgroundHypothermia is a problem for very premature infants after birth and leads to increased morbidity and mortality. Previously we found very premature infants exhibit abnormal thermal patterns, keeping foot temperatures warmer than abdominal temperatures for their first 12 h of life.PurposeWe explored the utility of infrared thermography as a non-invasive method for measuring body temperature in premature infants in an attempt to regionally examine differential temperatures.ResultsOur use of infrared imaging to measure abdominal and foot temperature for extremely premature infants in heated, humid incubators was successful and in close agreement using Bland and Altman technique with temperatures measured by skin thermistors.ConclusionsOur study methods demonstrated that it was feasible to capture full body temperatures of extremely premature infants while they were resting in a heated, humid incubator using a Flir SC640 infrared camera. This technology offers researchers and clinicians a method to examine acute changes in perfusion differentials in premature infants which may lead to morbidity.     

Within-day and between-days reliability of quadriceps isometric muscle fatigue using mechanomyography on healthy subjects

This study aimed to examine within-day and between-days intratester reliability of mechanomyography (MMG) in assessing muscle fatigue. An accelerometer was used to detect the MMG signal from rectus femoris. Thirty one healthy subjects (15 males) with no prior knee problems initially performed three maximum voluntary contractions (MVCs) using an ISOCOM dynamometer. After 10 min rest, subjects performed a fatiguing protocol in which they performed three isometric knee extensions at 75% MVC for 40 s. The fatiguing protocol was repeated on two other days, two to four days apart for between-days reliability. MMG activity was determined by overall root mean squared amplitude (RMS), mean power frequency (MPF) and median frequency (MF) during a 40 s contraction. RMS, MPF and MF linear regression slopes were also analysed. Intraclass Correlation Coefficients (ICC); ICC1,1 and ICC1,2 were used to assess within-day reliability and between-days reliability respectively. Standard error of measurement (SEM) and smallest detectable difference (SDD) described the within-subjects variability. MMG fatigue measures using linear regression slopes showed low reliability and large between-days error (ICC1,2 = 0.43–0.46; SDD = 306.0–324.8% for MPF and MF slopes respectively). Overall MPF and MF, on the other hand, were reliable with high ICCs and lower SDDs compared to linear slopes (ICC1,2 = 0.79–0.83; SDD = 21.9–22.8% for MPF and MF respectively). ICC1,2 for overall MMG RMS and linear RMS slopes were 0.81 and 0.66 respectively; however, the SDDs were high (56.4% and 268.8% respectively). The poor between-days reliability found in this study suggests caution in using MMG RMS, MPF and MF and their corresponding slopes in assessing muscle fatigue.     

Shear wave elastography of the supraspinatus muscle and tendon: Repeatability and preliminary findings

Shear wave elastography (SWE) is a promising tool for estimating musculoskeletal tissue properties, but few studies have rigorously assessed its repeatability and sources of error. The objectives of this study were to assess: (1) the extent to which probe positioning error and human user error influence measurement accuracy, (2) intra-user, inter-user, and day-to-day repeatability, and (3) the extent to which active and passive conditions affect shear wave speed (SWS) repeatability. Probe positioning and human usage errors were assessed by acquiring SWE images from custom ultrasound phantoms. Intra- and inter-user repeatability were assessed by two users acquiring five trials of supraspinatus muscle and tendon SWE images from ten human subjects. To assess day-to-day repeatability, five of the subjects were tested a second time, approximately 24 h later. Imaging of the phantoms indicated high inter-user repeatability, with intraclass correlation coefficient (ICC) values of 0.68–0.85, and RMS errors of no more than 4.1%. SWE imaging of the supraspinatus muscle and tendon had high repeatability, with intra- and inter-user ICC values of greater than 0.87 and 0.73, respectively. Day-to-day repeatability demonstrated ICC values greater than 0.33 for passive muscle, 0.48 for passive tendon, 0.65 for active muscle, and 0.94 for active tendon. This study indicates the technique has good to very good intra- and inter-user repeatability, and day-to-day repeatability is appreciably higher when SWE images are acquired under a low level of muscle activation. The findings from this study establish the feasibility and repeatability of SWE for acquiring data longitudinally in human subjects.     

Ultrashort echo time T21 values decrease in tendons with application of static tensile loads

In early stages of tendon disease, mechanical properties may become altered prior to changes in morphological anatomy. Ultrashort echo time (UTE) magnetic resonance imaging (MRI) can be used to directly detect signal from tissues with very short T2 values, including unique viscoelastic tissues such as tendons. The purpose of this study was to use UTE sequences to measure T2¹, T1 and magnetization transfer ratio (MTR) variations of tendon samples under static tensile loads. Six human peroneal tendons were imaged before and under static loading using UTE sequences on a clinical 3 T MRI scanner. Tendons were divided into two static tensile loading groups: group A that underwent one-step loading (15 N) and group B that underwent two-step loading (15 and 30 N). The T2¹, T1 and MTR variations were investigated in two selected section regions of interest (ROIs), including whole and core sections. Mean T2¹ values for the first step of loading (groups A and B) in both whole section and core section ROIs were significantly decreased by 13 ± 7% (P = 0.028) and 16 ± 5% (P = 0.017), respectively. For the second loading step (group B), there was a consistent, but non-significant reduction in T2¹ value by 9 ± 2% (P = 0.059) and 7 ± 5% (P = 0.121) for whole and core sections, respectively. Mean T1 did not show any consistent changes for either loading steps (P > 0.05). Mean MTR increased slightly, but not significantly for both loading steps (P > 0.05). Significant differences were found only in T2¹ values of tendons by static tensile load application. Therefore, T2¹ monitoring during loading is suggested for quantitative investigation of the tendons biomechanics.     

Reliability of a modified motor unit number index (MUNIX) technique

IntroductionThe purpose of this study was to examine the relative and absolute between-day reliability of the motor unit number index (MUNIX).MethodsYoung, healthy adults (n = 19) attended two testing sessions separated by 4-weeks where their maximal pinch-grip strength, MUNIX, and motor unit size index (MUSIX) were assessed in the abductor pollicis brevis muscle. Reliability was assessed by intraclass correlation coefficients (ICC), coefficient of variation (CV) and limits of agreement (LOA).ResultsNo mean differences were observed for MUNIX or MUSIX. The CV for the MUNIX and MUSIX measures were between 13.5% and 17.5%. The ICC for both measures were moderate to moderately-high (0.73–0.76), The LOA for both indicated a homoscedastic relationship.DiscussionOur findings indicate moderate to moderately-high reliability for both MUNIX and MUSIX. Future work is needed to ensure both measures are reliable in other muscles and cohorts, and further investigations are required to examine the validity of MUNIX.