Shear-wave elastography for assessment of trapezius muscle stiffness: Reliability and association with low-level muscle activity

Žiga Kozinc, Nejc Šarabon, Žiga Kozinc, Nejc Šarabon

Abstract

Purpose: Shear-wave elastography has been recognized a useful tool for quantifying muscle stiffness, commonly reported as shear modulus, however the reports on reliability are often limited to test-retest correlations. In this study, we explored the reliability of shear-wave elastography for assessment of the trapezius muscle stiffness and its relationship with low-level muscle activity.

Methods: Twenty participants were included in a two-session experiment. Measurements of shear modulus and muscle activity were performed at rest and during low-level activity, induced by shoulder abduction without additional external resistance.

Results: Good to excellent intra-session repeatability (ICC > 0.80) and moderate inter-rater and inter-session reproducibility (ICC = 0.66-0.74) were observed. Typical errors were acceptable (7.6% of the mean value) only for intra-session measurements in resting conditions, but not acceptable for all conditions with low-level muscle activity (10.2-16.6% of the mean value). Inverse relationships between shear modulus and muscle activity at 40° and 60° of shoulder abduction (r = -0.53 and -0.57) were observed on a group level. We also found higher shear modulus in males compared to females, for the parallel probe position compared to the perpendicular position (in relation to muscle fiber orientation), and for the dominant side of the body compared to the non-dominant side.

Conclusions: This study showed an inverse relationship between muscle activity in low-level range and shear modulus on a group level, suggesting inherent passive stiffness could account for a larger portion of the variance (compared to muscle activity) in shear modulus when the muscle activity is low. Our results imply that shear-wave elastography can be used in research exploring muscle stiffness, however, caution is needed since only intra-session examination in resting conditions showed acceptable within-participant typical errors. The secondary analyses of the study showed higher shear modulus for males, for the non-dominant side of the body and for the parallel orientation of the ultrasound probe.

Conflict of interest statement

The authors declare that they have no conflict of interest. Nejc Šarabon was employed by a commercial company, S2P-Science to practice, Ltd. (Slovenia). The company did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1
Muscle activity and shear modulus were recorded in the same conditions, with the location of the electrode and the ultrasound probe at 50% of the line from the acromion to the spine of C7 (A). Measurements were performed in a relaxed position (B) and with shoulder abduction of 40° and 60° (C).
Fig 2
Fig 2
Examples of shear-wave scans in relaxed position (a), 40° of shoulder abduction (b), 60° of shoulder abduction (c) and for relaxed position with transverse probe positioning (d). Example of probe positioning on the subject is shown for the condition with 60°of shoulder abduction (e).

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