Scapular Dynamic Muscular Stiffness Assessed through Myotonometry: A Narrative Review
Abstract
:1. Introduction
2. Guidelines to Myotonometry Measurements of Muscular Stiffness and Obtained Data
- Equipment:
- Programming the data acquisition:
- Introducing participant data (as weight, height, gender, and dominant side) [9]
- Planning a “pattern composer”, this is, defining an assessment protocol regarding the muscles to include and their condition of assessment (rest or contraction), the subject position and the measurements side, location and nº of repetitions [9]
- Uploading the participant and assessment data to the myotonometry tool
- The assessor should guarantee the equipment’s stability and avoid the contact with external factors (as clothes) to not influence the device’s impulses neither the tissues oscillations [9];
- Coefficient of variation (total measurements’ variability according to subject, assessor and device accuracy): should be lower than 3% [9];
- Measurement point: superficial reference of the muscles of interest, based not only in previous studies using myotonometry [48], but also researches using tools as algometer [25,48] and electromyography [4,48,49]. For repeated measurements, the same measuring points as well as same muscular and environmental conditions (as time of the day and subject’s position), must be kept [9];
3. Myotonometry Psychometric Properties Regarding the Measure of Muscular Stiffness
3.1. Validity
3.2. Reliability
3.3. Responsiveness
4. Applicability of Myotonometry for Assessing Scapular Muscles Stiffness
Myotonometry Ability for Measuring Differences or Changes in Muscular Stiffness in Pain Conditions Involving Scapular Muscles
5. Points That Need to Be Addressed in Future Studies
- Myotonometry assessment of serratus anterior and levator scapulae muscles are needed to validate the purposed assessment points, to define the myotonometry psychometric properties considering these muscles and to increase the knowledge about these muscles’ mechanical properties.
- The myotonometry psychometric properties should also be researched in subjects with different conditions, such as pain.
- The use of myotonometry not only at rest condition but also during contraction, could bring new information that could help to standout adaptations in muscle stiffness modulation, given the muscular activity required and variation in the range of motion used in this muscular condition [112,113,114].
- In studies with the intention to infer about intervention effects, the inclusion of follow-up moments could help to understand whether stiffness changes will be kept over time.
6. Study Limitations
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Muscle | Correlation Values | ||
---|---|---|---|
Values (p Value) | Classification | ||
Upper trapezius | r = −0.25 to 0.50 (p > 0.05) [1] | Not statistically significant | |
Infraspinatus | r = 0.35 to 0.37 (p < 0.05) [4] | Fair | |
Rectus femoris | r = 0.398 to 0.416 (p < 0.05 and p < 0.01, respectively) [56] | ||
Biceps brachii | r = 0.479 to 0.583 (p < 0.05) [49] | Fair to Moderate | |
Gastrocnemius | r = 0.463 to 0.71 (p < 0.05 or p < 0.01) [4,18,56] | Fair to Good | |
Erector spinae | r = 0.51 to 0.54 (p < 0.05) [4] | Moderate | |
Biceps femoris | r = 0.594 to 0.652 (p < 0.01) [56] | ||
Tibialis anterior | r = 0.540 to 0.561 (p < 0.01) [56] |
Shear Wave Elastography | Myotonometry | |
---|---|---|
Instrument characteristics | • Objective [4,18] • Non-invasive [1,4,18] | |
Real-time [1,3,64] Required technical expertise [18] | Less expensive [1,4] Handheld [1,3,4] Easy to use [1,3,4,66] | |
Structures assessed | Deep [1,4] | Superficial [1,4] |
Type of stiffness measured | Passive [1,3]: resistance to elongation or shortening or, in physical terms, the change in tension per unit change in length [67] | Dynamic [1,25,68]: resistance to a force that deforms muscle initial shape [3,25,68] |
Measurement mode | Elastic [4]/shear [3] modulus, that uses ultrasound radiation forces [4] | Damped oscillation method following a dynamic transformation of the muscle in response to a short-term external mechanical impulse [69] |
Measurement process |
| |
Measurement Interpretation | Velocity of shear waves (proportional to shear modulus [64]) rise with increase in passive muscle stiffness [1,64] | Higher values of dynamic stiffness imply more energy to modify the shape of the tissue [3] |
Scapular muscles Assessed | In healthy subjects:
| In healthy subjects:
|
Results SWE vs. Myotonometry |
|
Muscle | Sample | Assessment Conditions | Reliability Values | |||
---|---|---|---|---|---|---|
Assessment Moment | Rater | Muscle Condition | ICC Values | Classification | ||
Upper trapezius | Healthy and MSKd | IS | Inter-rater | Rest | 0.97 [7] | Very high |
Healthy | IS | Intra-rater | Rest | 0.86 [48] | High | |
BD | 0.229 [25] to 0.86 [63] | Low to very high | ||||
IS | Inter-rater | Rest and contraction considered together | 0.97 [21] | Very high | ||
BD | Intra-rater | 0.97 [21] | Very high | |||
Middle trapezius | BD | Intra-rater | Rest | 0.813 to 0.963 [25] | High to very high | |
Lower trapezius | BD | Intra-rater | Rest | 0.820 to 0.926 [25] | High to very high | |
Infraspinatus | IS | Intra-rater | Rest | 0.98 [4] | High to very high | |
Contraction | 0.98 [4] | High to very high | ||||
Erector spinae | IS | Intra-rater | Rest | 1 [4] | High to very high | |
Contraction | 0.99 to 1 [4] | High to very high | ||||
Rectus femoris | IS | Intra-rater | Rest | 0.938 [56] | Very high | |
Contraction | 0.872 [56] | High | ||||
Vastus Lateralis | IS | Intra-rater | Rest | 0.97 [3] | Very high | |
BD | 0.93 [3] | Very high | ||||
Medial gastrocnemius | IS | Intra-rater | Rest | 0.904 [56] to 1 [4] | Very high | |
Contraction | 0.856 [56] to 0.99 [4] | High to very high | ||||
Biceps femoris | IS | Intra-rater | Rest | 0.884 [56] | High | |
Contraction | 0.861 [56] | High | ||||
Tibialis anterior | IS | Intra-rater | Rest | 0.880 [56] | High | |
Contraction | 0.894 [56] | High |
Muscle of Interest | Measurement Points |
---|---|
Upper trapezius C5/6 level | At the level of C5/C6 about 2 cm lateral from the midline [90] |
Upper trapezius C7 level | Mid-way between C7 spinous process and the angle of acromion [7,12,21,87,88,89] |
Middle trapezius | Mid-way from T4 spinous process to the medial border of spine of the scapulae [25] |
Lower Trapezius | Mid-way from T6 spinous process to the medial border of spine of the scapulae [25] OR Mid-point of the lateral border of the fibers of lower trapezius [25] |
Muscle of Interest | Measurement Points |
---|---|
Levator scapulae | Between the posterior margin of sternocleidomastoid and anterior margin of the upper trapezius [104,105,106,107], at level of C4/5 [90] |
SA upper/middle portion | Over the fourth rib, at the midpoint between the latissimus dorsi and the pectoralis major [93,94] |
SA lower portion | Over the seventh rib, in the midline of the axilla [93], for SA lower portion (SAlow) [93] |
Study Objective | Group | Muscle Assessed | SD (N/m) | p Value | |||
---|---|---|---|---|---|---|---|
Mild (until 3 in VAS) UT pain (20.83 ± 1.12 years old) [26] | BGc | ✓ | VAS 0 | UT (muscle belly) | 170.56 | 28.45 | p < 0.05 *, for VAS 3 in comparison with other 3 groups |
VAS 1 | 161.67 | 16.59 | |||||
VAS 2 | 160.48 | 20.72 | |||||
VAS 3 | 191.50 | 25.74 | |||||
IE | - | - | |||||
Moderate work-related neck disorders (30–55 years old) [77] | BGc | ✓ | Pain | UT (C5/6 and C7 level) | 301.50 | 23.50 | p = 0.006 * |
Control | 270.90 | 33.70 | |||||
IE | - | - | |||||
Unilateral chronic shoulder pain together with, at least, 2 sensitive sites (myofascial trigger points) (18–70 years old) [68] | BGc | X | Control (Us, before) | UT (trigger points) | 324.42 | 11.39 | p = 0.057 |
Control (Us, after) | 334.68 | 11.10 | |||||
Pain (before) | 332.32 | 10.97 | |||||
Pain (after) | 300.66 | 9.43 | |||||
IE | ✓ for Myofascial trigger-point Release | Pain (before vs. after) | p = 0.012 * | ||||
Long-standing, nonspecific and nontraumatic neck-shoulder pain (20–61 years old) [14] | BGc | X | Control (MB sites) | UT (15 adjacent points) | 237.80 | 42.8 | p = 0.273, for comparison of both measurement sites |
Control (Mt sites) | 327.50 | 55.9 | |||||
Pain (MB sites before) | 258.70 | 41.10 | |||||
Pain (Mt sites before) | 330.40 | 50.8 | |||||
IE | ✓ for Eccentric Training | Pain (MB sites after) | 226.80 | 20.00 | p < 0.001 *, for comparison in both measurement sites | ||
Pain (Mt sites after) | 287.30 | 47.80 | |||||
Subacromial impingement syndrome (49.20 ± 9.48 to 50.90 ± 9.10 years old) [78] | BGc | - | - | ||||
IE | ✓ for Thoracic mobilization and/or Extension exercise | Pain (TM before) | UT (center of muscle belly) | 257.90 | 29.03 | p = 0.001 * | |
Pain (TM after) | 232.50 | 20.49 | |||||
Pain (exercise before) | 257.70 | 19.33 | p = 0.001 * | ||||
Pain (exercise after) | 236.10 | 27.27 | |||||
Pain (TM plus exercise before) | 257.50 | 25.61 | p = 0.001 * | ||||
Pain (TM plus exercise after) | 223.00 | 32.83 | |||||
Stage II or III of unilateral frozen shoulder syndrome (38–74 years old) [66] | BGc | X | Control (Us, before) | UT (center of muscle belly) | ≈235 | _ | p > 0.05 |
Control (Us, 1 m after) | ≈215 | _ | |||||
Control (Us, 6 m after) | ≈200 | _ | |||||
Pain (before) | ≈240 | _ | |||||
Pain (1 m after) | ≈225 | _ | |||||
Pain (6 m after) | ≈220 | _ | |||||
IE | X for Manual manipulation (under anaesthesia) | Pain (before vs. after) | p > 0.05, for comparison in each assessment moments | ||||
Unilateral neck or shoulder pain and active myofascial trigger points in the trapezius muscle (19.8 ± 2.4 years old) [25] | BGc | - | - | ||||
IE | ✓ for Ischemic compression | Pain | UT (distally of muscle belly’s center) | 232.00 | 29.70 | p = 0.03 * | |
UT2 (proximally of muscle belly’s center) | 269.00 | 42.10 | |||||
MT | 405.30 | 192.10 | p = 0.40 | ||||
LT (mid-point) | 347.50 | 110.40 | p = 0.29 | ||||
LT (lateral border mid-point of muscle fibers) | 331.70 | 89.30 |
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Melo, A.S.C.; Cruz, E.B.; Vilas-Boas, J.P.; Sousa, A.S.P. Scapular Dynamic Muscular Stiffness Assessed through Myotonometry: A Narrative Review. Sensors 2022, 22, 2565. https://doi.org/10.3390/s22072565
Melo ASC, Cruz EB, Vilas-Boas JP, Sousa ASP. Scapular Dynamic Muscular Stiffness Assessed through Myotonometry: A Narrative Review. Sensors. 2022; 22(7):2565. https://doi.org/10.3390/s22072565
Chicago/Turabian StyleMelo, Ana S. C., Eduardo B. Cruz, João Paulo Vilas-Boas, and Andreia S. P. Sousa. 2022. "Scapular Dynamic Muscular Stiffness Assessed through Myotonometry: A Narrative Review" Sensors 22, no. 7: 2565. https://doi.org/10.3390/s22072565