Validation of grayscale-based quantitative ultrasound in manual wheelchair users: relationship to established clinical measures of shoulder pathology

Jennifer L Collinger, Bradley Fullerton, Bradley G Impink, Alicia M Koontz, Michael L Boninger, Jennifer L Collinger, Bradley Fullerton, Bradley G Impink, Alicia M Koontz, Michael L Boninger

Abstract

Objective: The primary aim of this study is to establish the validity of grayscale-based quantitative ultrasound (QUS) measures of the biceps and supraspinatus tendons.

Design: Nine QUS measures of the biceps and supraspinatus tendons were computed from ultrasound images collected from 67 manual wheelchair users. Shoulder pathology was measured using questionnaires, physical examination maneuvers, and a clinical ultrasound grading scale.

Results: Increased age, duration of wheelchair use, and body mass correlated with a darker and more homogenous tendon appearance. Subjects with pain during physical examination tests for biceps tenderness and acromioclavicular joint tenderness exhibited significantly different supraspinatus QUS values. Even when controlling for tendon depth, QUS measures of the biceps tendon differed significantly between subjects with healthy tendons, mild tendinosis, and severe tendinosis. Clinical grading of supraspinatus tendon health was correlated with QUS measures of the supraspinatus tendon.

Conclusions: QUS is valid method to quantify tendinopathy and may allow for early detection of tendinosis. Manual wheelchair users are at a high risk for developing shoulder tendon pathology and may benefit from QUS-based research that focuses on identifying interventions designed to reduce this risk.

Figures

Figure 1
Figure 1
Panel A illustrates a healthy biceps tendon with a strong fibrillar pattern. Panel B depicts a biceps tendon with severe tendinosis. The top border of the tendon is demarcated with arrows.
Figure 2
Figure 2
Quantitative ultrasound measures of the supraspinatus tendon for subjects with and without symptoms of biceps tendon tenderness and AC joint tenderness. * indicates significant difference (p

Figure 3

Box-plots showing the median and…

Figure 3

Box-plots showing the median and quartiles of raw quantitative ultrasound descriptors of biceps…

Figure 3
Box-plots showing the median and quartiles of raw quantitative ultrasound descriptors of biceps tendon appearance vs. biceps grade from the clinical ultrasound examination. Only 1 subject had a biceps grade of 3, and his data is represented as a single line for reference only. This subject's data was combined with the Biceps Grade = 2 group for statistical analyses. Post-hoc significant differences, when controlling for tendon depth below the skin, are noted as * (p

Figure 4

Scatter-plot of supraspinatus tendon width…

Figure 4

Scatter-plot of supraspinatus tendon width vs. supraspinatus grade from the clinical ultrasound examination.…

Figure 4
Scatter-plot of supraspinatus tendon width vs. supraspinatus grade from the clinical ultrasound examination. Mean values are denoted with a bold dash `-'. Only 1 subject had a supraspinatus grade of 6 so that subject's data is represented as a single dot.

Figure 5

Summary of relationships between increasing…

Figure 5

Summary of relationships between increasing tendinopathy and greyscale-based quantitative ultrasound.

Figure 5
Summary of relationships between increasing tendinopathy and greyscale-based quantitative ultrasound.
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References
    1. Teefey S, Middleton W, Yamaguchi K. Musculoskeletal Ultrasound: Shoulder Sonography: State of the Art. Radiol Clin North Am. 1999;37:767–85. - PubMed
    1. Churchill RS, Fehringer EV, Dubinsky TJ, Matsen FA., III Rotator cuff ultrasonography: diagnostic capabilities. J Am Acad Orthop Surg. 2004;12:6–11. - PubMed
    1. Leung JLY, Griffith JF. Sonography of Chronic Achilles Tendinopathy: A Case-Control Study. J Clin Ultrasound. 2008;36:27–32. - PubMed
    1. Brose SW, Boninger ML, Fullerton B, McCann T, Collinger JL, Impink BG, et al. Shoulder Ultrasound Abnormalities, Physical Examination Findings, and Pain in Manual Wheelchair Users with Spinal Cord Injury. Arch Phys Med Rehabil. 2008;89:2086–93. - PubMed
    1. Gardin A, Bruno J, Movin T, Kristoffersen-Wiberg M, Shalabi A. Magnetic Resonance Signal, Rather Than Tendon Volume, Correlates to Pain and Functional Impairment in Chronic Achilles Tendinopathy. Acta Radiol. 2006;7:718–24. - PubMed
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Figure 3
Figure 3
Box-plots showing the median and quartiles of raw quantitative ultrasound descriptors of biceps tendon appearance vs. biceps grade from the clinical ultrasound examination. Only 1 subject had a biceps grade of 3, and his data is represented as a single line for reference only. This subject's data was combined with the Biceps Grade = 2 group for statistical analyses. Post-hoc significant differences, when controlling for tendon depth below the skin, are noted as * (p

Figure 4

Scatter-plot of supraspinatus tendon width…

Figure 4

Scatter-plot of supraspinatus tendon width vs. supraspinatus grade from the clinical ultrasound examination.…

Figure 4
Scatter-plot of supraspinatus tendon width vs. supraspinatus grade from the clinical ultrasound examination. Mean values are denoted with a bold dash `-'. Only 1 subject had a supraspinatus grade of 6 so that subject's data is represented as a single dot.

Figure 5

Summary of relationships between increasing…

Figure 5

Summary of relationships between increasing tendinopathy and greyscale-based quantitative ultrasound.

Figure 5
Summary of relationships between increasing tendinopathy and greyscale-based quantitative ultrasound.
Figure 4
Figure 4
Scatter-plot of supraspinatus tendon width vs. supraspinatus grade from the clinical ultrasound examination. Mean values are denoted with a bold dash `-'. Only 1 subject had a supraspinatus grade of 6 so that subject's data is represented as a single dot.
Figure 5
Figure 5
Summary of relationships between increasing tendinopathy and greyscale-based quantitative ultrasound.

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