Search Results (50)

Purpose: The popliteus tendon (PT), though often overlooked, plays a vital role in the functional and mechanical stability of the posterolateral corner (PLC) of the knee. This narrative review consolidates the current anatomical, biomechanical, imaging, clinical, and surgical data on the PT, with an emphasis on its morphological variability and relevance in orthopedic sports medicine. Methods: A comprehensive review of the literature was conducted, including classical anatomical studies, recent classification systems, biomechanical evaluations, imaging protocols, and rehabilitation strategies. Particular focus was given to the anatomical classification proposed by Olewnik et al. and its implications in surgical and diagnostic contexts. Results: Anatomical investigations have demonstrated considerable variability in the PT, including bifid tendons and accessory fascicles. These variants have a measurable impact on preoperative planning, diagnostic imaging interpretation, and outcomes of surgical procedures, such as anterior cruciate ligament (ACL) and PLC reconstructions. The PT also contributes significantly to knee rotational control and meniscal stabilization, particularly in athletic populations. Imaging modalities, such as MRI and dynamic ultrasound, show high diagnostic utility, while arthroscopy remains the definitive diagnostic and therapeutic modality. Rehabilitation should emphasize neuromuscular re-education and progressive control of tibial rotation. A phase-based rehabilitation framework and clinical action table are proposed. Conclusions: The PT should be recognized as a critical structure in both the conservative and the surgical management of posterolateral and rotational knee instability. Enhanced awareness of its anatomical variability and functional importance can improve diagnostic accuracy, surgical precision, and clinical outcomes. In particular, MRI and high-resolution ultrasound can aid in identifying accessory fascicles and bifid tendons, while arthroscopy benefits from preoperative knowledge of PT variants to avoid misidentification and iatrogenic injury. Surgical planning for ACL and PLC reconstructions may be refined by applying the classification system described. Future research should focus on refining diagnostic algorithms, developing PT-specific functional tests, and integrating popliteus evaluation into high-level clinical decision-making and surgical navigation systems. Full article

This study investigated the effect of wearable ultrasound-imaging-based visual feedback (UVF) on assisting paretic ankle dorsiflexion training of chronic stroke survivors. Thirty-three participants with unilateral hemiplegia performed maximal isometric contractions on an isokinetic dynamometer in randomized conditions with and without UVF that provided by a wearable ultrasound imaging system. Torque parameters (mean, peak, percentage of maximal voluntary contraction) and tibialis anterior muscle thickness were analyzed across different contraction phases. Statistical comparisons were conducted using paired t-tests or Wilcoxon tests. Correlation analyses were performed using Pearson’s or Spearman’s tests. Results demonstrated that UVF significantly improved torque output, as evidence by the increased percentage of maximal voluntary contraction (%MVC) during entire contractions (p = 0.007), increased mean (p ≤ 0.022) and peak (p ≤ 0.044) torque and the %MVC (p ≤ 0.004) during mid and end phases, and larger muscle thickness during mid contraction (p = 0.045). Moderate correlations were found between torque and muscle thickness (r ≥ 0.30, p ≤ 0.049). These findings preliminarily supported the positive outcomes of real-time wearable UVFs in enhancing paretic ankle dorsiflexion strength and force control during isometric contractions in chronic stroke survivors. While the developed and validated new training protocol may potentially serve as a practical adjunct to existing rehabilitation approaches, further investigations emphasizing the functional outcomes and clinical translations are still needed to verify the clinical utility. Full article

Introduction: Median sternotomy carries post-surgical risks like sternal instability, requiring careful monitoring. Ultrasonography provides a real-time, quantitative assessment of sternal micromovements and has emerged as a promising tool for clinical evaluation. However, its reliability for assessing sternal micromovements post-surgery remains unclear. This study evaluated the inter-rater, intra-rater, and test–retest reliability of ultrasound performed by physiotherapists. Methods: Ultrasound was used to measure the distance between sternal edges in sternotomized patients along the X-axis and Y-axis. Measurements were taken under a resting position, during cough, and in two supine-to-sitting postural transitions (one using a rotational modality and the other with an individual device). Real-time ultrasound imaging acquisition was followed by off-line data elaboration. Assessments were conducted by multiple physiotherapists after a brief training period. Reliability was determined using intraclass correlation coefficients (ICCs), along with the standard error of measurement (SEM) and minimum detectable change (MDC90). ICC values > 0.75 were classified as excellent. Results: A total of 33 subjects with median sternotomy were included (5 women, age 66 ± 7 years). All reliability measurements (24 total) were rated as excellent in each condition examined, with intra-rater ICCs exceeding 0.90, except for on the X-axis during the postural transition using the individual device for supine-to-sitting. SEM values ranged from 0.23 to 0.64 mm, while MDC90 values ranged from 0.54 to 1.50 mm. Conclusions: Ultrasound demonstrated excellent reliability for assessing sternal micromotions when performed by physiotherapists with brief training. Given its reliability, cost-effectiveness, and ease of use, ultrasound sternal micromotions assessment could be integrated into post-surgical rehabilitation to enhance patient care. Full article

Ultrasound-guided botulinum toxin type A (BoNT-A) injections have become an essential tool in the management of lower limb spasticity. Following our previous work, which focused on upper limb muscles, this third part provides a detailed visual guide to the identification and injection of proximal lower limb muscles frequently involved in spastic gait and posture disorders. This guide presents the ultrasound anatomy, clinical relevance, and injection strategies for eleven key muscles: gluteus maximus, piriformis, psoas major, rectus femoris, sartorius, gracilis, adductor longus, adductor magnus, semimembranosus, semitendinosus, and biceps femoris. For each muscle, the Elias University Hospital (EUH) model is applied, highlighting the zones of maximum thickness and motor point density to ensure precise and effective BoNT-A delivery. Enhanced with high-resolution ultrasound images and dynamic scanning techniques, this visual guide supports clinicians in performing safe, targeted injections. It serves as both an educational and practical reference for the ultrasound-guided treatment of spasticity in the proximal lower limb, completing the series and offering a standardized framework for comprehensive BoNT-A management. By promoting accurate toxin delivery, this approach is expected to improve functional mobility, reduce spasticity-related complications, and optimize patient-centered outcomes in rehabilitation settings. Full article

Artificial intelligence (AI) has rapidly emerged as a transformative force in musculoskeletal imaging and interventional radiology. This article explores how AI-based methods—including machine learning (ML) and deep learning (DL)—streamline diagnostic processes, guide interventions, and improve patient outcomes. Key applications discussed include ultrasound-guided procedures for joints, nerves, and tumor-targeted interventions, along with CT-guided biopsies and ablations, and fluoroscopy-guided facet joint and nerve block injections. AI-powered segmentation algorithms, real-time feedback systems, and dose-optimization protocols collectively enable greater precision, operator consistency, and patient safety. In rehabilitation, AI-driven wearables and predictive models facilitate personalized exercise programs that can accelerate recovery and enhance long-term function. While challenges persist—such as data standardization, regulatory hurdles, and clinical adoption—ongoing interdisciplinary collaboration, federated learning models, and the integration of genomic and environmental data hold promise for expanding AI’s capabilities. As personalized medicine continues to advance, AI is poised to refine risk stratification, reduce radiation exposure, and support minimally invasive, patient-specific interventions, ultimately reshaping musculoskeletal care from early detection and diagnosis to individualized treatment and rehabilitation. Full article

Spasticity often occurs following neurological disorders such as traumatic brain injury, cerebral palsy, and stroke. Botulinum toxin (BTX) injections, especially when paired with rehabilitation, are among the most effective interventions for these patients. Various techniques for administering BTX injections to the upper limb muscles have been described. However, a standardized method for ultrasound-guided injections in the intrinsic muscles of the hand remains quite scant in the literature. The authors suggest a novel dorsal approach to treat the most common abnormal postural patterns in hand spasticity, thumb-in-palm, and intrinsic plus. This approach facilitates access to the muscles while minimizing patient discomfort, as it avoids the need to open forcibly the spastic hand. The adductor pollicis, flexor pollicis brevis, lumbrical, and interosseus muscles have been identified as primary anatomical targets to improve hand posture and function. Standardized sonographic scans are leveled with anatomical illustrations and probe/patient positioning images for interventional procedures. Additionally, tips and techniques for promptly identifying vascular bundles are included to enhance the safety of the procedures. This technical report aims to provide an easy and ready-to-use tool in clinical practice for injecting intrinsic hand muscles in spastic patients, utilizing a novel dorsal approach. Full article

A 75-year-old man, with a history of descending thoracic aortic rupture and dissection treated with aortic stenting at 73 years old, was admitted for rehabilitation following recurrent cerebral ischemic attacks. Upon admission, blood tests revealed elevated inflammatory markers, including a C-reactive protein (CRP) level of 10.75 mg/dL and a D-dimer level of 4.2 µg/mL, alongside microcytic anemia. Despite thorough evaluations using computed tomography (CT) and ultrasound, the origin of these abnormalities remained unidentified. Two months later, MRI using diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) revealed hyperintensities in the thoracic aorta. He remained asymptomatic and progressed well during rehabilitation, prompting continued observation. However, three months after admission, he developed hemoptysis. Contrast-enhanced CT showed pneumonia, as well as enhanced lesions in the aortic wall, confirming aortic inflammation. Due to concerns about aortic stent ulceration, an emergency stent graft insertion extending to the superior mesenteric artery was performed. He recovered uneventfully and was discharged. DWIBS is an MRI-based tool that avoids exposure to radiation or contrast agents and is cost-effective. MRI using DWIBS demonstrated high signal accumulations in the aortic wall, indicative of inflammation. These findings suggest that DWIBS holds significant potential as a powerful imaging tool for detecting and assessing inflammation, particularly in the aorta. Full article

The accurate assessment of muscle morphology and function is crucial for medical diagnostics, rehabilitation, and biomechanical research. This study presents a novel methodology for constructing volumetric models of forearm muscles based on three-dimensional ultrasound imaging integrated with a robotic system to ensure precise probe positioning and controlled pressure application. The proposed ultrasound scanning approach combined with a collaborative six-degrees-of-freedom robotic manipulator enabled reproducible and high-resolution imaging of muscle structures in both relaxed and contracted states. A custom-built phantom, acoustically similar to biological tissues, was developed to validate the method. The cross-sectional area of the muscles and the coordinates of the center of mass of the sections, as well as the volume and center of gravity of each muscle, were calculated for each cross-section of the reconstructed forearm muscle models at contraction. The method’s feasibility was confirmed by comparing the reconstructed volumes with anatomical data and phantom measurements. This study highlights the advantages of robotic-assisted ultrasound imaging for non-invasive muscle assessment and suggests its potential applications in neuromuscular diagnostics, prosthetics design, and rehabilitation monitoring. Full article

Background and Objectives: Pilates-based core stabilization training has garnered increasing attention for its potential to improve deep muscle activation and enhance spinal stability. This study aimed to investigate the effects of Pilates-based core stabilization training on deep stabilizing muscles using rehabilitative ultrasound imaging (RUSI). Materials and Methods: A total of 57 healthy adults aged 20 to 29 years were recruited and randomly allocated to either an experimental group (n = 29) or a control group (n = 28). Participants in the experimental group engaged in Pilates-based core stabilization training three times per week for six weeks, while the control group performed aerobic exercises. The pre- and post-intervention assessments included measurements of muscle thickness, contraction timing, and contraction ratios of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, evaluated using RUSI. Results: The experimental group demonstrated significant improvements in TrA and IO thickness (p < 0.05), contraction timing (p < 0.05), and contraction ratios (p < 0.05) compared to the control group. The EO muscle also showed significant, albeit less pronounced, enhancements in thickness and contraction ratios. Conclusions: Pilates-based core stabilization training significantly improves core muscle function, including muscle thickness, contraction timing, and contraction ratios. These findings support the inclusion of Pilates exercises in clinical protocols aimed at enhancing core stability. Full article

Background: Home rehabilitation improves patient satisfaction and reduces the need for specialist consultations. Hemodialysis is a costly post-ICU service that requires frequent monitoring. Previous studies have demonstrated the feasibility and accuracy of patients self-scanning their lungs with an ultrasound device within the hospital. Methods: In this single-center, prospective pilot study, we compared the quality of high-risk elderly patient-generated lung ultrasound images against physician-generated images as our primary outcome. The secondary outcome assessed image quality and B-line quantification between a home device and a gold standard device, when operated by the same clinician. Results: We enrolled nine participants (66% male, median age 76 years [IQR 66,79]). Analysis included 402 ultrasound clips (163 patient-generated, 239 physician-generated, and 237 in-clinic gold standard clips). Patient-generated images demonstrated high reliability (92% highly reliable or reliable) and were non-inferior to physician-generated images (p < 0.001). There was substantial agreement in B-line classification (Kw = 0.64, 95% CI: 0.46–0.82). The home device, when operated by the same physician, showed non-inferiority to the gold standard device (p < 0.001) with substantial B-line classification agreement (Kw = 0.64, 95% CI: 0.51–0.78). Conclusions: High-risk elderly patients can successfully generate self-scanned lung ultrasound images comparable to those produced by physicians. These promising results warrant further investigation through larger-scale and long-term studies. Full article

Background/Objectives: Lymphedema, a common source of disability among oncology patients, necessitates continuous targeted rehabilitation. Recent studies have revealed the role of connective tissue in this pathology; however, despite existing research on ultrasound (US) use in lymphedema, no studies have specifically addressed the use of ultrasound to assess fasciae in patients with lymphedema. This study aims to provide a more objective characterization of typical US alterations in these patients by quantifying the thickness of superficial and deep fasciae and comparing them with those of healthy volunteers. Methods: A cross-sectional study was performed using US imaging to measure the thickness of superficial and deep fascia in different regions and levels of the arm and forearm in a sample of 50 subjects: 25 chronic lymphedema patients and 25 healthy participants. Results: No significant difference in fascial thickness was observed between affected and unaffected upper limbs, but patients had notably thinner superficial fascia and deep fascia compared with healthy volunteers. The findings for superficial and deep fascia revealed statistically significant differences (p < 0.0001) in all regions and levels. Conclusions: This study demonstrates the effectiveness of US imaging as a non-invasive tool for detecting subtle fascial changes in chronic lymphedema patients, revealing thinner fasciae compared with those in healthy volunteers. These findings suggest a potential anatomical predisposition to lymphedema, highlighting the importance of incorporating detailed US assessments in diagnosis and management to improve early intervention and patient outcomes. Future studies could, therefore, investigate whether preventive fascia assessment might improve the early identification of individuals at risk. Full article

Lower back pain (LBP) has been the leading cause of disability since 1990. Objectives: The main objective of this observational case–control study was to evaluate, using ultrasound, whether there were differences in the onset and ratio of core muscle contraction between subjects with non-specific chronic lower back pain and healthy subjects. Methods: A total of 60 participants (52% women), split between those with non-specific chronic lower back pain (n = 26) and healthy (n = 34) subjects, were recruited. Initial muscle contraction of the lateral abdominal wall, pelvic floor, lumbar multifidus, and respiratory diaphragm was measured using ultrasound. The abdominal drawing-in maneuver, contralateral arm elevation, the Valsalva maneuver, and voluntary contraction of the pelvic floor in seated and standing positions were performed. The muscle thickness of the lateral abdominal wall and lumbar multifidus and excursion of the pelvic floor and diaphragm at rest and during testing were also analyzed. Results: No differences were found between the groups in the initial contraction. Statistically significant differences were found in the following variables: diaphragm excursion (p = 0.032, r = 0.277) and lumbar multifidus ratio (p = 0.010, r = 0.333) in the standing–abdominal retraction maneuver; pelvic floor excursion (p = 0.012, r = 0.325) in the standing–contralateral arm raise; and transverse abdominis ratio (p = 0.033, r = 0.275) in the sitting–contralateral arm raise. A statistically significant interaction between the groups and body mass index was observed in resting diaphragm excursion (p = 0.018, partial eta squared = 0.096) during sitting–voluntary pelvic floor contraction. Conclusions: It cannot be concluded that there is a specific pattern of core activation in any of the groups. However, statistically significant differences were found in the contraction indexes of the lumbopelvic musculature. Full article

Rehabilitation from musculoskeletal injuries focuses on reestablishing and monitoring muscle activation patterns to accurately produce force. The aim of this study is to explore the use of a novel low-powered wearable distributed Simultaneous Musculoskeletal Assessment with Real-Time Ultrasound (SMART-US) device to predict force during an isometric squat task. Participants (N = 5) performed maximum isometric squats under two medical imaging techniques; clinical musculoskeletal motion mode (m-mode) ultrasound on the dominant vastus lateralis and SMART-US sensors placed on the rectus femoris, vastus lateralis, medial hamstring, and vastus medialis. Ultrasound features were extracted, and a linear ridge regression model was used to predict ground reaction force. The performance of ultrasound features to predict measured force was tested using either the Clinical M-mode, SMART-US sensors on the vastus lateralis (SMART-US: VL), rectus femoris (SMART-US: RF), medial hamstring (SMART-US: MH), and vastus medialis (SMART-US: VMO) or utilized all four SMART-US sensors (Distributed SMART-US). Model training showed that the Clinical M-mode and the Distributed SMART-US model were both significantly different from the SMART-US: VL, SMART-US: MH, SMART-US: RF, and SMART-US: VMO models (p < 0.05). Model validation showed that the Distributed SMART-US model had an R² of 0.80 ± 0.04 and was significantly different from SMART-US: VL but not from the Clinical M-mode model. In conclusion, a novel wearable distributed SMART-US system can predict ground reaction force using machine learning, demonstrating the feasibility of wearable ultrasound imaging for ground reaction force estimation. Full article

Functional electrical stimulation (FES) is a vital method in neurorehabilitation used to reanimate paralyzed muscles, enhance the size and strength of atrophied muscles, and reduce spasticity. FES often leads to increased muscle fatigue, necessitating careful monitoring of the patient’s response. Ultrasound (US) imaging has been utilized to provide valuable insights into FES-induced fatigue by assessing changes in muscle thickness, stiffness, and strain. Current commercial FES electrodes lack sufficient US transparency, hindering the observation of muscle activity beneath the skin where the electrodes are placed. US-compatible electrodes are essential for accurate imaging and optimal FES performance, especially given the spatial constraints of conventional US probes and the need to monitor muscle areas directly beneath the electrodes. This study introduces specially designed body-conforming US-compatible FES (US-FES) electrodes constructed with a silver nanowire/polydimethylsiloxane (AgNW/PDMS) composite. We compared the performance of our body-conforming US-FES electrode with a commercial hydrogel electrode. The findings revealed that our US-FES electrode exhibited comparable conductivity and performance to the commercial one. Furthermore, US compatibility was investigated through phantom and in vivo tests, showing significant compatibility even during FES, unlike the commercial electrode. The results indicated that US-FES electrodes hold significant promise for the real-time monitoring of muscle activity during FES in clinical rehabilitative applications. Full article

The semimembranosus muscle inserts into several tendons that are associated with some pathologies. Although ultrasound is useful for studying, diagnosing, and managing these pathologies, the correct interpretation of any images requires a clear knowledge of the related anatomical structures and the inter-related functions. We studied 38 cryopreserved non-paired knees from adult anatomical specimens and 4 non-paired knees from 29 to 38-week-old fetuses. The semimembranosus muscle and its tendons were located, observed, and injected under ultrasound guidance. The macroscopic anatomy was studied using dissection and anatomical cuts and the tendons were analyzed histologically. Measurements of muscle were taken 10 cm from the medial epicondyle and just before the tendon divided. The ultrasound facilitated the identification of the different divisions of the tendon of semimembranosus muscle and the rotation of the muscle and tendon from medial to posterior. An anatomical study confirmed this rotation and revealed an average width, thickness, and diameter of 38.29 mm, 14.36 mm, and 112.64 mm, respectively. Important relationships were observed between the divisions of the main tendons and the medial collateral ligament, the posterior side of the knee and popliteus muscle. This information can help to explain knee pathologies and facilitate rehabilitation after surgery. Full article