Search Results (30)

Background: Chronic post-stroke spasticity often limits gait despite best-practice botulinum-toxin intramuscular injections (BTIs), whose benefit is constrained by short duration, dose ceilings, and tachyphylaxis. Cryoneurolysis (CNL) induces a reversible axonotmesis with preserved endoneurium, potentially providing longer tone reduction with fewer adverse effects, but its impact on whole-gait quality and its compatibility with implanted functional electrical stimulation (FES) remain poorly documented. Case presentation: A 43-year-old man, 12 years after right middle cerebral artery stroke, walked independently with an implanted common peroneal FES system but complained of effortful gait with left-knee “locking” and drop foot without FES. Multiple BTI series to triceps surae and quadriceps yielded only transient benefit. Two ultrasound-guided CNL sessions targeted tibial (soleus, medial gastrocnemius) and femoral (rectus femoris, vastus intermedius) motor branches. Quantitative gait analysis and fine-wire electromyography (EMG) were performed at baseline, 6 weeks after each CNL, and at 6 months, with and without FES. CNL produced immediate and sustained reductions in triceps surae and quadriceps overactivity, resolution of genu recurvatum, normalization of stiff-knee gait, improved ankle dorsiflexion, and increased swing phase knee flexion (>50°). Gait Deviation Index rose from 69 to 80 and Gillette Gait Index decreased by more than 50%, with preserved strength and without adverse events. Conclusions: Targeted, sequential CNL of tibial and femoral motor branches can safely deliver durable, clinically meaningful gait improvements when BTI has reached its ceiling and can act synergistically with implanted FES. Quantitative gait analysis and EMG sharpen clinical decision-making in spasticity management. Full article

Background and Clinical Significance: Hemiplegia following a cerebrovascular accident (CVA) disrupts gait symmetry and efficiency, compromising functional independence. The integration of surface electromyography (sEMG) and inertial measurement units (IMU) enables quantitative assessment of muscle activation and segmental dynamics, providing objective data for therapeutic planning. Case presentation: A 57-year-old male with chronic right hemiplegia, eight years post-ischemic stroke of the left middle cerebral artery. The patient ambulated independently without assistive devices, exhibiting right lower-limb circumduction. Clinical assessment revealed the following scores: Barthel Index 85/100, Tinetti Performance-Oriented Mobility Assessment (POMA) 16/28, Timed Up and Go (TUG) test 13 s, and Modified Ashworth Scale (MAS) scores of 1 (upper limb) and 1+ (lower limb). Methods: Multichannel sEMG (Miotool 800^®, 8 channels) was recorded form the lumbar erectors, gluteus medius and maximus, vastus medialis, vastus intermedius, vastus lateralis, biceps femoris, tibialis anterior, medial gastrocnemius, and lateral gastrocnemius. Ag/AgCI electrodes were positioned according to SENIAM recommendations: sampling rate: 1000 Hz; band-pass filter: 20–500 Hz; notch filter: 60 Hz; normalization to %MVC. Simultaneously, IMU signals (Xsens DOT^®, 60 Hz) were collected from both ankles during slow, medium and fast walking (20 s each) and compared with a healthy control subject. Results: The patient exhibited reduced sEMG amplitude and increased peak irregularity on the affected side, particularly in the gluteus medius, tibialis anterior, and gastrocnemius, along with agonist desynchronication. IMU data revealed decreased range of motion and angular pattern irregularity, with inconsistent acceleration peaks in the right ankle compared to the control, confirming neuromuscular and kinematic asymmetry. Conclusions: The combined sEMG-IMU analysis identified deficits in selective motor control and propulsion on the affected hemibody, providing essential information to guide physiotherapeutic interventions targeting pelvic stability, dorsiflexion, and propulsive phase training, enabling objective follow-up beyond specialized laboratory settings. Full article

Background/Objectives: Despite the increasing use of ultrasound (US) as a tool for assessing muscle mass and diagnosing sarcopenia, its application remains limited because few studies have validated cut-off points for specific populations. This study aimed to propose US cut-off points for diagnosing sarcopenia in Brazilian individuals aged 60 years and older. Methods: Patients schedule for elective abdominal computed tomography (CT) were also evaluated with musculoskeletal US of the thigh. CT images were obtained at the level of the third lumbar vertebra. US measurements included the thickness of the rectus femoris (RF) muscle and the rectus femoris combined with the vastus intermedius (RF + VI). Receiver Operating Characteristic (ROC) curves determine the sensitivity and specificity of the US cut-off points. The area under the curve (AUC) and 95% confidence intervals (CI) were calculated. Results: The study sample (n = 88) had a mean age of 71.8 ± 8.7 years, and 64% were women. The proposed cut-off points for diagnosing sarcopenia using US, based on the mean ± SD, were ≤19.1 mm and ≤15.9 mm for RF thickness and ≤31.9 mm and ≤29.2 mm for RF + VI thickness in men and women, respectively. These cut-off points demonstrated good accuracy and significant AUC values. Conclusions: This study proposes US-based cut-off points with good accuracy for suggesting sarcopenia diagnosis, particularly when assessing RF thickness. Full article

Background: This pilot longitudinal observational study investigated 4-week changes in lower limb muscle quantity and quality in patients with subacute stroke and explored risk factors associated with these changes. Methods: Twenty-six patients with hemiplegia following subacute stroke underwent assessment at baseline and 4-week follow-up. Muscle quantity was evaluated by ultrasound muscle thickness and bioelectrical impedance analysis, while muscle quality was assessed by shear-wave elastography in seven muscles (rectus femoris, vastus intermedius, vastus lateralis [VL], vastus medialis, tibialis anterior, gastrocnemius [GCM], and soleus). Electrophysiological assessments included motor-evoked potential (MEP), somatosensory-evoked potential (SEP), nerve conduction studies (NCSs), and central motor conduction time (CMCT). Results: Muscle thickness and bioimpedance did not significantly change between baseline and follow-up. In contrast, shear modulus increased in the paretic-side VL and GCM muscles (p < 0.001 and p = 0.049), with no differences in the non-paretic side. Greater deterioration in GCM quality was observed in patients with abnormal lower-limb MEP, and increased VL stiffness correlated with prolonged CMCT. Multivariable analyses were performed adjusting for age, sex, National Institutes of Health Stroke Scale, and comorbidity burden; however, due to the small electrophysiology sample (n = 11), these results should be interpreted as exploratory. Conclusions: In subacute stroke, early deterioration in muscle quality can occur despite stable quantity and appears linked to corticospinal integrity. Integrating electrophysiological evaluation with elastography may help identify patients who could benefit from early, targeted neuromuscular rehabilitation. These exploratory findings require validation in larger cohorts. Full article

Background: Ultrasound (U/S) can be used to evaluate skeletal muscle characteristics in clinical and sports settings. Handheld U/S devices have recently emerged as a cheaper and portable alternative to conventional U/S systems. However, further research is warranted on their reliability. We assessed the reliability and inter-device agreement between a handheld U/S device (Clarius L15 HD₃) and a more conventional U/S system (GE LOGIQ e) for measuring the thickness of the rectus femoris (RF) and vastus intermedius (VI). Methods: Cross-sectional images of the RF and VI muscles were obtained in 20 participants by two assessors, and on two separate occasions by one of those assessors, using the Clarius L15 HD₃ and GE LOGIQ e devices. RF and VI thickness measurements were obtained to determine the intra-rater reliability, inter-rater reliability, and inter-device agreement. Results: All intraclass correlation coefficients (ICCs) were above 0.9 for intra-rater reliability (range: 0.94 to 0.97), inter-rater reliability (ICC: 0.97), and inter-device agreement (ICC: 0.98) when comparing the two devices in assessing RF and VI thickness. For the RF, the Bland–Altman plot revealed a mean difference of 0.06 ± 0.07 cm, with limits of agreement ranging from 0.21 to −0.09, whereas for the VI, the Bland–Altman plot showed a mean difference of 0.07 ± 0.10 cm, with limits of agreement ranging from 0.27 to −0.13. Conclusions: The handheld Clarius L15 HD₃ was reliable and demonstrated high agreement with the more conventional GE LOGIQ e for assessing the thickness of the RF and VI in young, healthy adults. Full article

Background: The quadriceps femoris (QF) muscle is traditionally described as a four-headed structure (QF4), yet recent anatomical studies have identified significant morphological variations, including accessory heads and complex quadriceps femoris tendon (QFT) layering. These anatomical differences are especially relevant when harvesting the QFT for anterior cruciate ligament (ACL) reconstruction, where graft quality and structure are critical to surgical success. This study aimed to systematically review and quantitatively synthesize available data on QF variants, with a focus on accessory heads and tendon architecture. Methods: This systematic review and meta-analysis followed PRISMA 2020 and Evidence-Based Anatomy Workgroup guidelines. Cadaveric studies reporting QF variants were identified through searches of multiple databases and anatomical journals. Pooled prevalence estimates and mean QFT lengths were calculated using random-effects models. Heterogeneity and publication bias were also assessed. Results: Eighteen studies encompassing 1066 lower limbs met inclusion criteria. The five-headed QF (QF5) was the most common variant (54.11%), followed by the classical four-headed form (QF4) (40.74%). Rare morphologies with six to eight heads (QF6–QF8) were also documented. Among accessory heads, the vastus lateralis (VL) type was most prevalent (21.35%), while an independent tensor vastus intermedius (TVI) occurred in 13.54% of limbs. The QFT most frequently displayed a trilaminar structure (47.73%), with quadrilaminar architecture observed in 42.49%. The mean QFT length was 78.63 mm. Conclusions: This meta-analysis confirms that the QF often deviates from classical anatomical descriptions, frequently exhibiting supernumerary heads and multilayered tendon architecture. These findings highlight the importance of detailed preoperative imaging and personalized surgical planning to minimize complications and optimize graft selection in ACL reconstruction. Full article

Backgrounds and Objectives: In this study, we aimed to assess preoperative frailty among hospitalized patients over 60 undergoing colorectal cancer surgery. We investigated the impacts of frailty and sarcopenia on postoperative recovery, complications, and discharge time, while also identifying a cost-effective, bedside-accessible USG parameter for diagnosing sarcopenia among patients assessed using the “Sonographic Thigh Adjustment Ratio” method. Materials and Methods: In this prospective study, we investigated the impacts of frailty and sarcopenia on the postoperative outcomes of 42 geriatric patients (with American Society of Anesthesiologists (ASA) scores of I–III) undergoing colorectal cancer surgery under general anesthesia. Frailty was assessed using the FRAIL scale, and sarcopenia was evaluated using the STAR (sonographic thigh adjustment ratio). Ultrasonographic measurements of rectus femoris and vastus intermedius muscle thicknesses were taken, and thigh lengths (TLs) were recorded. Ratios, including rectus femoris thickness/TL (RFT/TL), vastus intermedius thickness/TL (VIT/TL), and total muscle thickness/TL (TMT/TL), were calculated. Postoperative anesthesia recovery was monitored using the Modified Aldrete Score, indicating the time until discharge from the recovery unit. Complications were classified using the Clavien–Dindo system, and hospital discharge times were noted. Results: We observed significant differences between frailty status and ASA scores, as well as between age and frailty status. Muscle thickness significantly differed between the frail and pre-frail patients. Among the sarcopenic patients, age differences were significant. In men, VIT/TL was significantly correlated with sarcopenia diagnosis, whereas, in women, RFT/TL, VIT/TL, and TMT/TL were all correlated with sarcopenia. Conclusions: Based on our results, we conclude that VIT/TL measurement can serve as a predictive marker for preoperative sarcopenia, optimizing patient health before surgery. Full article

The purpose of this study was to examine changes in body fat, muscle mass, muscle thickness, and physical and cardiorespiratory fitness in overweight and obese individuals following progressive Tabata training. Thirty-six participants were randomly assigned to either the Tabata group (four progressive cycles of body-weight high-intensity intermittent training at 75–85% of maximum perceived exertion, 3 days/week for 12 weeks) or the control group. Body composition, muscle thickness, strength and endurance, and peak oxygen uptake (VO₂peak) were measured at baseline and after the training period and compared between groups. No changes in body fat percentage and fat mass were found, but the waist-to-hip ratio was lower in the Tabata group (p = 0.043). The muscle mass percentages of the right (p = 0.026) and left legs (p = 0.043) increased, while the muscle thicknesses of the biceps, triceps, rectus femoris, and vastus intermedius were increased in the Tabata group (p < 0.05) to a greater extent than in the control group (p < 0.05). Muscle strength and endurance (p < 0.05), as well as VO₂peak (p = 0.006), also increased in the Tabata group. Twelve weeks of modified Tabata training effectively increased muscle mass and thickness and physical and cardiorespiratory fitness, although it did not reduce fat mass in overweight and obese participants. The combination of this training with a dietary intervention may have a more obvious impact. Full article

Objectives: Muscles and their tendons present a considerable diversity of morphological variations. The aim of this study was to explore variants of muscles and tendons from compartments of the thigh and to raise awareness about potential problems during ultrasound examination. Materials and Methods: This comprehensive review of the literature was created on the basis of scientific articles sourced from PubMed. The search included all relevant papers related to the topic, ensuring that the most up-to-date studies were incorporated. In order to achieve these results, we created the exclusion criteria and extracted papers that did not meet the requirements of our review. Relevant papers were incorporated, and tracking of citations was fulfilled. The described method allowed for a broad yet detailed understanding, ensuring that the review of the literature covers all key aspects of the presented research. Results: Various aspects of thigh muscle anomalies were already undertaken; however, as this study has shown, current knowledge, while valuable, is insufficient to draw definitive conclusions regarding the prevalence and clinical implications of these muscle variations. A more robust body of ultrasound-based research is essential to accurately characterize these anomalies, establish their frequency, and assess their impact on clinical decision-making, including diagnostic accuracy, surgical planning, and therapeutic interventions. Conclusions: Numerous anatomical variations of the thigh muscles and tendons that were described in literature over the years might have clinical implications and could lead to mistakes during diagnosis by ultrasound imaging. Full article

Background and Objectives: Despite extensive studies of the role of quadriceps and quadriceps/hamstring balance in knee osteoarthritis (OA), the roles of the vastus intermedius, medialis, and lateralis in OA remain unclear. The purpose of this study was to investigate the relationship of lower limb alignment and the ratio of the quadriceps femoris muscle to the knee extensor muscle. Materials and Methods: This study included 50 patients with advanced knee OA (Kellgren/Lawrence grade of 3 or 4) and 25 healthy control persons between June 2021 and May 2022. The osteoarthritis grade and anatomical tibiofemoral angle were measured based on plain radiography and scanography. All participants were divided into normal (0~5°), mild varus (5°~10°), and severe varus (>10°) groups. Using MRI, muscle size was determined by calculating the cross-sectional area (CSA) of the total quadriceps (rectus femoris, vastus intermedius, vastus medialis, and vastus lateralis) and its components. Results: The CSA ratio of the vastus lateralis was significantly smaller in the severe varus group than in the normal or mild varus groups. There was a significant positive correlation between the mechanical tibiofemoral angle and vastus lateralis CSA (ρ = 0.282, p = 0.014) and between the anatomical tibiofemoral angle and vastus lateralis CSA (ρ = 0.294, p = 0.011). There was a significant negative correlation between the mechanical tibiofemoral angle and vastus intermedius CSA (ρ = −0.263, p = 0.023) and between the anatomical tibiofemoral angle and vastus intermedius CSA (ρ = −0.243, p = 0.036). Conclusions: Patients with severe varus alignment exhibited vastus lateralis atrophy. This study highlights vastus lateralis atrophy in severe varus alignment, though causality between atrophy and varus knee OA remains uncertain. We think that patients with severe varus may require strengthening exercises focused on the vastus lateralis before and after surgery for alignment correction. Full article

Background: COVID-19 pneumonia is associated with SIRS and hypercatabolism. The aim of this study was to determine muscle loss during the acute phase of COVID-19 pneumonia and evaluate long-term sequelae in discharged patients. Methods: A total of 16 patients with COVID-19 pneumonia and respiratory insufficiency were included in the study. Selected parameters (weight, BMI, LBM = lean body mass, albumin, CRP, NLR = neutrophil-to-lymphocyte ratio, ultrasound measured thickness of rectus femoris muscle = US RF and rectus femoris + vastus intermedius = US RF + VI, handgrip strength, quality of life = EQ-5D questionnaire, and activities of daily living = Barthel’s ADLs) were recorded on admission, discharge, and 1, 3, and 6 months after discharge. Results: The most significant changes were between hospital admission and discharge: US RF and RF + VI (−1.28 ± 1.97 mm, p = 0.046; −1.76 ± 2.94 mm, p = 0.05), EQ-5D score (14.6 ± 19.2, p = 0.02), and ADLs (17.1 ± 22.6; p = 0.02). There was a significant positive correlation between US RF + VI and handgrip strength (p = 0.014) and a negative correlation between weight and Barthel index (p = 0.012). There was an association between muscle function with an EQ-5D score and ADLs during outpatient check-ups, most noticeably between handgrip strength, US RF+VI, and ADLs (p = 0.08; p = 0.1, respectively). Conclusions: In patients with COVID-19 pneumonia, there is a significant reduction of health-related quality of life, impaired even 6 months after hospital discharge, influenced mainly by muscle loss. During the hospital stay, there was a significant muscle mass reduction. Ultrasound measurement of thigh muscle thickness may be a useful method to monitor muscle loss. Full article

Elucidating its dynamic interaction within the knee joint, this exploration delves into the awareness regarding the articularis genus muscle for ultrasound-guided suprapatellar recess injections. While injections into the infrapatellar recess may proceed without ultrasound guidance, we highlight concerns regarding the potential cartilage injury. In contrast, especially with ultrasound guidance, suprapatellar recess injections significantly mitigate this risk, especially in the case of collapsed recess. Originating from the distal femur and vastus intermedius, the articularis genus muscle influences the tension of the suprapatellar recess during knee motion. Sonographically identifying this muscle involves visualizing the slender linear structure of the suprapatellar recess, with guidance on differentiation from the vastus intermedius. We provide a succinct approach to ultrasound-guided suprapatellar recess injections, emphasizing needle insertion techniques and strategies to prevent fluid accumulation. In conclusion, this study serves as a concise clinician’s guide, underscoring the significance of the articularis genus muscle’s sonoanatomy in ultrasound-guided suprapatellar recess injections. Ultimately, procedural precision and patient safety can be advanced in this aspect. Full article

The quadriceps femoris muscle (QF) is of clinical importance since it has been correlated with pathologies at knee level, such as anterior cruciate ligament (ACL) injury, pain processes and complex clinical conditions. Among the variables that have been related to these clinical conditions are anthropometric measurements, architecture and muscular behavior of the QF. The aim of this study was to determine the relationship between the rectus femoris (RF) and vastus intermedius (VIM) muscles’ behavior measured by rehabilitative ultrasound imaging (RUSI) M-mode under maximal voluntary isometric contraction (MVIC) and anthropometric measurements. This was a cross-sectional, observational study. Sixty-two asymptomatic volunteers were included (20.42 ± 4.97 years, most women 59.7%). RUSI measurements were muscle contraction/rest thickness and contraction/relaxation velocity. Anthropometric measurements were, lower limb length, RF length, QF tendon length, distance between spines, proximal, middle and distal thigh perimeter. Statistically significant correlations (p < 0.05) were found between VIM thickness at rest and contraction with thigh perimetry, RF length and dominant lower limb length. For the RF, a correlation was found between the thickness at rest and the length of this muscle (p = 0.003). There is a correlation between anthropometric variables and muscular behavior measured by RUSI M-mode. Full article

The present study investigated effects of squat resistance training on intermuscular hypertrophy of quadriceps femoris muscles (i.e., rectus femoris, RF; vastus intermedius, VI; vastus medialis, VM; and vastus lateralis, VL). Eighteen university students (age: 24.1 ± 1.7 years, 9 females) underwent 7 weeks of parallel squat training (2 days/week) preceded by a 2-week familiarization period. Squat strength (1RM) and cross-sectional area (CSA) of four quadriceps muscles were assessed at baseline and at the end of the study. At posttest, 1RM and CSA of quadriceps muscles significantly increased (p < 0.01), with moderate-to-large effect (ES = 1.25–2.11) for 1RM (8.33 ± 6.64 kg), VM CSA (0.12 ± 0.08 cm²), and VL CSA (0.19 ± 0.09 cm²) and small effect (ES = 0.89–1.13) for RF CSA (0.17 ± 0.15 cm²) and VI CSA (0.16 ± 0.18 cm²). No significant differences were found in the changes of CSA between muscles (F = 0.638, p = 0.593). However, the squat 1RM gain was significantly associated only with the changes in CSA of the VL muscle (r = 0.717, p < 0.001). The parallel squat resulted in significant growth of all quadriceps muscles. However, the novelty of this study is that the increase in strength is associated only with hypertrophy of the VL muscle. Full article

The aim of the present study was to investigate which of the four musle heads of the quadriceps femoris is the best surrogate of quadriceps hypertrophy, following resistance training, evaluated by ultrasonography. Forty three physical education students (age: 22.1 ± 3.1 years, height: 175.2 ± 9.3 cm, mass: 75.3 ± 8.0 kg, BMI: 22.8 ± 2.8 kg·m⁻²) participated in the study. Participants followed an 8-week resistance training program in order to enhance quandriceps muscle hypertrophy. Before and after the training period muscle ultrasonography was used to evaluate: total quandriceps (T), vastus lateralis (VL), vastus intermidius (VI), vastus medialis (VM) and rectus femoris (RF) cross sectional area (CSA). Total quadriceps’ as well as VL, VI and VM, CSAs were significantly increased after training (changes ranged between 10.9 ± 9.9% and 18.6 ± 10.8%; p < 0.05). No significant changes were found for RF CSA after training (p > 0.05). Agreement analyses revealed high values for VL and VI (e.g., ICC = 0.879–0.915; p = 0.000), and low values for VM and RF (e.g., ICC = 0.132–0.526; p = 0.000). These results suggest that training-induced changes in muscle hypertrophy in VL and VI measured via muscle ultrasonography may be significantly predict the whole quadriceps hypertrophy in response to lower body resistance training. Consequently, VL and VI may considered as valid surrogates of whole quadriceps muscle hypertrophy. Full article