Search Results (26)

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

Objective: To quantify the spatial heterogeneity of displacement during voluntary isometric contraction within and between the different compartments of the quadriceps. Methods: The thigh muscles of seven subjects were imaged on an MRI scanner while performing isometric knee extensions at 40% maximal voluntary contraction. A gated velocity-encoded phase contrast MRI sequence in axial orientations yielded tissue velocity-encoded dynamic images of the four different compartments of the thigh muscles (vastus lateralis (VL), vastus medialis (VM), vastus intermedius (VI), and rectus femoris (RF)) at three longitudinal locations of the proximal–distal length: 17.5% (proximal), 50% (middle), and 77.5% (distal). The displacement, which is the time integration of the measured velocity, was calculated along the three orthogonal axes using a tracking algorithm. Results: The displacement of the muscle tissues was clearly nonuniform within each axial section as well as between the three axial locations. The ensemble average of the magnitude of the total displacement as a synthetic vector of the X, Y, and Z displacements was significantly larger in the VM at the middle location (p < 0.01), and in the VI at the distal location than in the other three muscles. The ensemble average of Z-axis displacement, which was almost aligned with the line of action, was significantly larger in VI than in the other three muscles in all three locations. Displacements of more than 20 mm were observed around the central aponeuroses, such as those between VI and the other surrounding muscles. Conclusions: These results imply that the quadriceps muscles act as one functional unit in normal force generation through the central aponeuroses despite complex behavior in each of the muscles, each of which possesses different physiological characteristics and architectures. Full article

Background: Rheumatoid arthritis (RA) is an autoimmune, inflammatory and chronic disease that may lead to loss of muscle mass, muscle strength and decreased functionality. Our objectives are to assess the quadriceps muscle morphology by ultrasound (MU) and verify its associations with clinical features, muscle strength and physical function in RA patients. Methods: In this cross-sectional study, RA women (≥18 years) were included. Morphological parameters in quadriceps muscle consisted of the muscle thickness and pennation angle of rectus femoris (RF), vastus intermedius (VI) and vastus lateralis (VL). RA activity was measured by a 28-joint disease activity score (DAS28), muscle strength by handgrip and chair stand tests, and physical function by health assessment questionnaire (HAQ), timed-up-and-go (TUG) test and short physical performance battery (SPPB). Results: Fifty-five patients were included (age: 56.73 ± 9.46 years; DAS28: 3.08 ± 1.29). Muscle thickness in RF, VI and VL were negatively associated with age (RF, p < 0.001; VI, p = 0.013; VL, p = 0.002) and disease duration (RF, p < 0.001; VI, p = 0.005; VL, p = 0.001), and were positively associated with handgrip strength (RF, p = 0.015; VI, p = 0.022; VL, p = 0.013). In addition, decreased muscle thickness in VI (p = 0.035) and a smaller pennation angle in RF (p = 0.030) were associated with higher DAS-28 scores. Conclusion: Quadriceps muscle morphology by ultrasound appears to be affected by age, disease duration, disease activity and muscle strength in patients with RA. MU can be a useful method to evaluate the impact of the disease on skeletal muscle. Full article

The tensor of vastus intermedius is a newly discovered muscle that is located at the anterior compartment of the thigh. The aim of the present study is to report, assess and synthetize the existing evidence on the anatomy, variation and morphological characteristics of the TVI as well as to examine its clinical importance. A systematic review was performed evaluating both anatomical and medical imaging studies which provided information about TVI anatomy, prevalence, variations and morphological characteristics. The search strategy was conducted in major electronic databases. Two reviewers worked independently to screen all possible references via a title/abstract examination. Methodological quality was examined with the Anatomical Quality Assurance checklist. A total of 295 cadaveric knees were included in the nine studies where in 244 (82.7%) cases the TVI was identified. Based on this evidence, it appears that the TVI is located between the vastus lateralis and vastus intermedius. The muscle belly is located proximally, and it is combined with a broad and flat aponeurosis before forming a tendinous structure that is attached at the medial aspect of the patella. The TVI presented some morphological variations and complex muscle architecture that varied along its length. There is insufficient good quality evidence as more than half of the included studies were ranked as having a “High” risk of bias with various methodological issues. Higher quality studies are recommended to evaluate the TVI morphology to better understand its functional and clinical importance. Full article

Background: The aim of this work was to assess whether the muscle thickness and echogenicity were associated with dysphagia, malnutrition, sarcopenia, and functional capacity in acute hospital admission for a hip fracture. Methods: Observational study that assessed nutritional status by Global Leadership Initiative on Malnutrition, risk of dysphagia and sarcopenia by European Working Group on Sarcopenia in Older People and Barthel functional index. We measured muscle thickness and echogenicity of masseter, bicipital, and quadriceps rectus femoris (RF) and vastus intermedius (VI) by ultrasound. Results: One hundred and one patients were included in the study (29.7% sarcopenia and 43.8% malnutrition). Logistic regression models adjusted for age, sex, and body mass index showed an inverse association of the masseter thickness with both sarcopenia (OR: 0.56) and malnutrition (OR: 0.38) and quadriceps with sarcopenia (OR: 0.74). In addition, patients at high risk of dysphagia had lower masseter thickness (p: 0.0001) while patients able to self-feeding had thicker biceps (p: 0.002) and individuals with mobility on level surfaces higher thickness of biceps (p: 0.008) and quadriceps (p: 0.04). Conclusion: Thickness of the masseter was associated with risk of dysphagia, biceps with the ability to self-feed, and that of the quadriceps RF-VI with mobility. Full article