Human muscle hardness assessment during incremental isometric contraction using transient elastography

The aim of this study was to investigate the relationship between biceps brachii hardness using the transient elastography technique, and its activity level by quantifying the surface electromyographic signal (sEMG). Ten healthy subjects volunteered for this protocol. To assess the maximal biceps brachii myoelectric activity (sEMG-RMSm), subjects had to achieve their maximal voluntary contraction trial during an elbow flexion effort. They were then asked to perform an isometric biceps sEMG-RMS ramp trial in elbow flexion from 0% to 50% of their sEMG-RMSm in 120 s. A low-frequency pulse was sent every 5 s during all trials by an innovative shear elasticity probe previously placed over the belly of the biceps brachii allowing the calculation of a transverse shear modulus. The main results of this study were (i) the finding of a systematic linear relationship between the biceps brachii transverse shear moduli and the corresponding sEMG-RMS values. This was not the case when plotting transverse shear modulus versus the elbow flexion torque production. Therefore, the computation of a hardness index from the slope of individual transverse shear modulus-sEMG-RMS linear relationship was enabled; (ii) It was also found that the higher is the rest shear modulus, the lower is the hardness index, indicating that the transverse shear modulus change during contraction depends on its level at rest. Therefore, this non-invasive technique could be useful in the medical field to explore deep muscles which are unreachable by classical testing methods. It could also be applied for the follow-up of neuromuscular diseases inducing stiffness changes such as in Duchenne muscular dystrophy.