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Surgical and Radiologic Anatomy

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01-12-2018 | Review

Morphometric and dynamic measurements of muscular fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature

Authors: Caterina Fede, Nathaly Gaudreault, Chenglei Fan, Veronica Macchi, Raffaele De Caro, Carla Stecco

Published in: Surgical and Radiologic Anatomy | Issue 12/2018

Abstract

Purpose

The objectives of this work was to conduct a comprehensive state-of-the art review of the current literature to identify any gaps or discrepancies and summarize the main challenges for obtaining a homogeneous evaluation of muscular fascia in healthy individuals.

Methods

An electronic document search using key words and MeSH terms was performed with various databases. Two independent investigators were tasked with the screening of articles and data extraction. A critical appraisal of what is known was then conducted.

Results

The literature search identified 65 articles related to healthy facia in the various databases consulted and 20 articles were kept for the review. The thickest portion of the fascia lata (the iliotibial tract) and the plantar fascia are the most often studied muscular fasciae whereas there is paucity of studies on fascia related to other muscles in the body.

Conclusion

US imaging is suitable to complement physical examination and for evaluating treatment outcomes. However, the small number of studies and the heterogeneity of the methods did not allow us to establish normal reference values for muscular fascia thickness and to provide strong recommendations about measurement protocols.

Adstrum S, Hedley G, Schleip R, Stecco C, Yucesoy CA (2017) Defining the fascial system. J Bodyw Mov Ther 21:173–177. https://doi.org/10.1016/j.jbmt.2016.11.003 PubMedCrossRef

Benjamin M (2008) The fascia of the limbs and back—a review. J Anat 214:1–18. https://doi.org/10.1111/j.1469-7580.2008.01011.x CrossRef

Bernabei M, Maas H, van Dieën JH (2016) A lumped stiffness model of intermuscular and extramuscular myofascial pathways of force transmission. Biomech Model Mechanobiol 15:1747–1763. https://doi.org/10.1007/s10237-016-0795-0 PubMedPubMedCentralCrossRef

Bhansing KJ, Van Rosmalen MH, Van Engelen BG, Vonk MC, Van Riel PL, Pillen S (2015) Increased fascial thickness of the deltoid muscle in dermatomyositis and polymyositis: an ultrasound study. Muscle Nerve 52:534–539. https://doi.org/10.1002/mus.24595 PubMedCrossRef

Brandenburg JE, Eby SF, Song P, Zhao H, Brault JS, Chen S, An K-N (2014) Ultrasound elastography: the new frontier in direct measurement of muscle stiffness. Arch Phys Med Rehabil 95:2207–2219. https://doi.org/10.1016/j.apmr.2014.07.007 PubMedPubMedCentralCrossRef

Braun IF, Hoffman JC, Reede D, Grist W (1984) Computed tomography of the buccomasseteric region: 2. Pathol Am J Neuroradiol 5:611–616

Buford TW, Lott DJ, Marzetti E, Wohlgemuth SE, Vandenborne K, Pahor M, Leeuwenburgh C, Manini TM (2012) Age-related differences in lower extremity tissue compartments and associations with physical function in older adults. Exp Gerontol 47:38–44. https://doi.org/10.1016/j.exger.2011.10.001 PubMedCrossRef

Chaitow L (2014) Somatic dysfunction and fascia’s gliding-potential. J Bodyw Mov Ther 18:1–3. https://doi.org/10.1016/j.jbmt.2013.11.019 PubMedCrossRef

Condino S, Turini G, Parrini S, Stecco A, Busoni F, Ferrari V, Ferrari M, Gesi M (2015) A semiautomatic method for in vivo three-dimensional quantitative analysis of fascial layers mobility based on 3D ultrasound scans. Int J Comput Assist Radiol Surg 10:1721–1735. https://doi.org/10.1007/s11548-015-1167-4 PubMedCrossRef

10.

Cowman MK, Schmidt TA, Raghavan P, Stecco A (2015) Viscoelastic properties of hyaluronan in physiological conditions. F100 0Research 4:622. https://doi.org/10.12688/f1000research.6885.1 CrossRef

11.

Cruz-Montecinos C, Gonzalez Blanche A, Lopez Sanchez D, Cerda M, Sanzana-Cuche R, Cuesta-Vargas A (2015) In vivo relationship between pelvis motion and deep fascia displacement of the medial gastrocnemius: anatomical and functional implications. J Anat 227:665–672. https://doi.org/10.1111/joa.12370 PubMedPubMedCentralCrossRef

12.

Csapo R, Malis V, Hodgson J, Sinha S (2014) Age-related greater Achilles tendon compliance is not associated with larger plantar flexor muscle fascicle strains in senior women. J Appl Physiol (1985) 116:961–969. https://doi.org/10.1152/japplphysiol.01337.2013 CrossRef

13.

Day JA, Stecco C, Stecco A (2014) Application of Fascial Manipulation technique in chronic shoulder pain: Anatomical basis and clinical implications. J Bodyw Mov Ther 13:128–135. https://doi.org/10.1016/j.jbmt.2008.04.044 CrossRef

14.

Draghi F, Gitto S, Bortolotto C, Draghi AG, Ori Belometti G (2017) Imaging of plantar fascia disorders: findings on plain radiography, ultrasound and magnetic resonance imaging. Insights Imaging 8:69–78. https://doi.org/10.1007/s13244-016-0533-2 PubMedCrossRef

15.

Drakonaki EE, Allen GM, Wilson DJ (2009) Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clin Radiol 64:1196–1202. https://doi.org/10.1016/j.crad.2009.08.006 PubMedCrossRef

16.

Federative Committee of Anatomical Terminology (FCAT) (1998) Terminologia anatomica: international anatomical terminology. Thieme Verlag, Stuttgart

17.

Gadalla N, Kichouh M, Boulet C, Machiels F, De Mey J, De Maeseneer M (2014) Sonographic evaluation of the plantar fascia in asymptomatic subjects. JBR-BTR 97:271–273PubMed

18.

Goh LA, Chhem RK, Wang SC, Chee T (2003) Iliotibial band thickness: sonographic measurements in asymptomatic volunteers. J Clin Ultrasound 31:239–244. https://doi.org/10.1002/jcu.10168 PubMedCrossRef

19.

Grant MJ, Booth A (2009) A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J 26:91–108. https://doi.org/10.1111/j.1471-1842.2009.00848.x PubMedCrossRef

20.

Gyaran IA, Spiezia F, Hudson Z, Maffulli N (2011) Sonographic measurement of iliotibial band thickness: an observational study in healthy adult volunteers. Knee Surg Sports Traumatol Arthrosc 19:458–461. https://doi.org/10.1007/s00167-010-1269-z PubMedCrossRef

21.

Harley JJ (2016) Reliability of deep cervical fascia and sternocleidomastoid thickness measurements using ultrasound imaging. An unpublished thesis submitted in partial fulfilment for the requirements for the Unitec degree of Master of Osteopathy, Unitec Institute of Technology, New Zealand., Unitec Institute of Technology

22.

Harley OJH, Pickford MA (2013) CT analysis of fat distribution superficial and deep to the Scarpa’s fascial layer in the mid and lower abdomen. J Plast Reconstr Aesthetic Surg 66:525–530. https://doi.org/10.1016/j.bjps.2012.12.003 CrossRef

23.

Hyun-sook K, Tae-lim Y (2012) Comparison of relative thickness of the Iliotibial Band following four self-stretching exercises. Phys Ther Korea 19:24–31CrossRef

24.

Ichikawa K, Takei H, Usa H, Mitomo S, Ogawa D (2015) Comparative analysis of ultrasound changes in the vastus lateralis muscle following myofascial release and thermotherapy: a pilot study. J Bodyw Mov Ther 19:327–336. https://doi.org/10.1016/j.jbmt.2014.11.018 PubMedCrossRef

25.

Kent-Braun JA, Ng AV, Young K (2000) Skeletal muscle contractile and noncontractile components in young and older women and men. J Appl Physiol (1985) 88:662–668. https://doi.org/10.1152/jappl.2000.88.2.662 CrossRef

26.

Kragstrup TW, Kjaer M, Mackey AL (2011) Structural, biochemical, cellular, and functional changes in skeletal muscle extracellular matrix with aging. Scand J Med Sci Sports 21:749–757. https://doi.org/10.1111/j.1600-0838.2011.01377.x PubMedCrossRef

27.

Kumka M, Bonar J (2012) Fascia: a morphological description and classification system based on a literature review. J Can Chiropract Assoc 56:179–191

28.

Kwong EH, Findley TW (2014) Fascia–Current knowledge and future directions in physiatry: narrative review. J Rehabil Res Dev 51:875–884. https://doi.org/10.1682/jrrd.2013.10.0220 PubMedCrossRef

29.

Langevin HM, Bouffard NA, Fox JR, Palmer BM, Wu J, Iatridis JC, Barnes WD, Badger GJ, Howe AK (2011) Fibroblast cytoskeletal remodeling contributes to conncetive tissue tension. J Cell Physiol 226:1166–1175. https://doi.org/10.1002/jcp.22442 PubMedPubMedCentralCrossRef

30.

Langevin HM, Fox JR, Koptiuch C, Badger GJ, Greenan- Naumann AC, Bouffard NA, Konofagou EE, Lee W-N, Triano JJ, Henry SM (2011) Reduced thoracolumbar fascia shear strain in human chronic low back pain. BMC Musculoskelet Disord 12:203. https://doi.org/10.1186/1471-2474-12-203 PubMedPubMedCentralCrossRef

31.

Langevin HM, Stevens-Tuttle D, Fox JR, Badger GJ, Bouffard NA, Krag MH, Wu J, Henry SM (2009) Ultrasound evidence of altered lumbar connective tissue structure in human subjects with chronic low back pain. BMC Musculoskelet Disord 10:151. https://doi.org/10.1186/1471-2474-10-151 PubMedPubMedCentralCrossRef

32.

Liptan GL (2010) Fascia: A missing link in our understanding of the pathology of fibromyalgia. J Bodyw Mov Ther 14:3–12. https://doi.org/10.1016/j.jbmt.2009.08.003 PubMedCrossRef

33.

Luomala T, Pihlman M, Heiskanen J, Stecco C (2014) Case study: could ultrasound and elastography visualized densified areas inside the deep fascia? J Bodyw Mov Ther 18:462–468. https://doi.org/10.1016/j.jbmt.2013.11.020 PubMedCrossRef

34.

McKinnis LN (2014) Fundamentals of musculoskeletal imaging, Contemporary Perspectives in Rehabilitation, 4th edn, chap 1. F.A. Davis Company, pp 27–28

35.

Mikkelsen UR, Agergaard J, Couppe C, Grosset JF, Karlsen A, Magnusson SP, Schjerling P, Kjaer M, Mackey AL (2017) Skeletal muscle morphology and regulatory signalling in endurance-trained and sedentary individuals: the influence of ageing. Exp Gerontol 93:54–67. https://doi.org/10.1016/j.exger.2017.04.001 PubMedCrossRef

36.

Mota P, Pascoal AG, Sancho F, Carita AI, Bø K (2013) Reliability of the inter-rectus distance measured by palpation. Comparison of palpation and ultrasound measurements. Man Ther 18:294–298. https://doi.org/10.1016/j.math.2012.10.013 PubMedCrossRef

37.

Myers TW (2013) Anatomy trains, Myofascial Meridians for Manual and Movement Therapists, 3rd edn. Churchill Livingstone Elsevier, Edinburgh

38.

International Anatomical Nomenclature Committee (1983) Nomina anatomica, 5th edn. Williams & Wilkins, Baltimore

39.

Park D-J, Hwang Y-I (2016) A pilot study of balance performance benefit of myofascial release, with a tennis ball, in chronic stroke patients. J Bodyw Mov Ther 20:98–103. https://doi.org/10.1016/j.jbmt.2015.06.009 PubMedCrossRef

40.

Pavan PG, Stecco A, Stern R, Stecco C (2014) Painful connections: densification versus fibrosis of fascia. Curr Pain Headache Rep 18:441. https://doi.org/10.1007/s11916-014-0441-4 PubMedCrossRef

41.

Pratelli E, Pintucci M, Cultrera P, Baldini E, Stecco A, Petrocelli A, Pasquetti P (2015) Conservative treatment of carpal tunnel syndrome: comparison between laser therapy and fascial manipulation®. J Bodyw Mov Ther 19:113–118. https://doi.org/10.1016/j.jbmt.2014.08.002 PubMedCrossRef

42.

Rathleff MS, Moelgaard C, Lykkegaard Olesen J (2011) Intra- and interobserver reliability of quantitative ultrasound measurement of the plantar fascia. J Clin Ultrasound 39:128–134. https://doi.org/10.1002/jcu.20787 PubMedCrossRef

43.

Rios-Diaz J, Martinez-Paya JJ, del Bano-Aledo ME, de Groot-Ferrando A, Botia-Castillo P, Fernandez-Rodriguez D (2015) Sonoelastography of plantar fascia: reproducibility and pattern description in healthy subjects and symptomatic subjects. Ultrasound Med Biol 41:2605–2613. https://doi.org/10.1016/j.ultrasmedbio.2015.05.024 PubMedCrossRef

44.

Rozin AP, Schapira D, Braun-Moscovici Y, Markovits D, Vlodavsky E, Balbir-Gurman A (2008) Ultrasound imaging of fasciitis due to body-building supplement. Am J Med Sci 335:242–245. https://doi.org/10.1097/MAJ.0b013e3180ed454c PubMedCrossRef

45.

Schilder A, Hoheisel U, Magerl W, Benrath J, Klein T, Treede RD (2014) Sensory findings after stimulation of the thoracolumbar fascia with hypertonic saline suggest its contribution to low back pain. Pain 155:222–231. https://doi.org/10.1016/j.pain.2013.09.025 PubMedCrossRef

46.

Schmidt TL, Weiner DS (1982) Calcaneal fractures in children. An evaluation of the nature of the injury in 56 children. Clin Orthop Relat Res 171:150–155

47.

Stecco A, Gesi M, Stecco C, Stern R (2013) Fascial components of the myofascial pain syndrome. Curr Pain Headache Rep 17:352. https://doi.org/10.1007/s11916-013-0352-9 PubMedCrossRef

48.

Stecco A, Meneghini A, Stern R, Stecco C, Imamura M (2014) Ultrasonography in myofascial neck pain: randomized clinical trial for diagnosis and follow-up. Surg Radiol Anat 36:243–253. https://doi.org/10.1007/s00276-013-1185-2 PubMedCrossRef

49.

Stecco C, Gagey O, Belloni A, Pozzuoli A, Porzionato A, Macchi V, Aldegheri R, De Caro R, Delmas V (2007) Anatomy of the deep fascia of the upper limb. Second part: study of innervation. Morphologie 91:38–43. https://doi.org/10.1016/j.morpho.2007.05.002 PubMedCrossRef

50.

Stecco C (2015) Functional atlas of the human fascial system, 1st edn. Churchill Livingstone Elsevier, Edinburgh

51.

Stecco C, Stern R, Porzionato A, Macchi V, Masiero S, Stecco A, De Caro R (2011) Hyaluronan within fascia in the etiology of myofascial pain. Surg Radiol Anat 33:891–896. https://doi.org/10.1007/s00276-011-0876-9 PubMedCrossRef

52.

Stecco C, Corradin M, Macchi V, Morra A, Porzionato A, Biz C, De Caro R (2013) Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. J Anat 223:665–676. https://doi.org/10.1111/joa.12111 PubMedPubMedCentralCrossRef

53.

Strandring S (2016) Gray’s anatomy: the anatomical basis of clinical practice, 41th edn. Elsevier Churchill Livingstone, Edinburgh

54.

Theodorou DJ, Theodorou SJ, Resnick D (2002) MR Imaging of Abnormalities of the Plantar Fascia. Semin Musculoskelet Radiol 06:105–118. https://doi.org/10.1055/s-2002-32357 CrossRef

55.

Turini G, Condino S, Stecco A, Ferrari V, Ferrari M, Gesi M (2015) A 3D sparse motion field filtering for quantitative analysis of fascial layers mobility based on 3D ultrasound scans. Conf Proc IEEE Eng Med Biol Soc 2015:775–780. https://doi.org/10.1109/EMBC.2015.7318477 PubMedCrossRef

56.

van der Wal J (2009) The architecture of the connective tissue in the musculoskeletal system—an often overlooked functional parameter as to proprioception in the locomotor apparatus. Int J Ther Massage Bodyw 2:9–23

57.

Wang HK, Ting-Fang Shih T, Lin KH, Wang TG (2008) Real-time morphologic changes of the iliotibial band during therapeutic stretching; an ultrasonographic study. Man Ther 13:334–340. https://doi.org/10.1016/j.math.2007.03.002 PubMedCrossRef

58.

Welk AB, Haun DW, Clark TB, Kettner NW (2015) Use of high-resolution ultrasound to measure changes in plantar fascia thickness resulting from tissue creep in runners and walkers. J Manip Physiol Ther 38:81–85. https://doi.org/10.1016/j.jmpt.2014.10.008 CrossRef

59.

Wilke J, Schleip R, Klingler W, Stecco C (2017) The lumbodorsal fascia as a potential source of low back pain: a narrative review. BioMed Res Int. https://doi.org/10.1155/2017/5349620 PubMedPubMedCentralCrossRef

60.

Wilke J, Schleip R, Yucesoy CA, Banzer W (2017) Not merely a protective packing organ? A review of fascia and its force transmission capacity. J Appl Physiol 124:234–244. https://doi.org/10.1152/japplphysiol.00565.2017 PubMedCrossRef

Title: Morphometric and dynamic measurements of muscular fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature
Authors: Caterina Fede
Nathaly Gaudreault
Chenglei Fan
Veronica Macchi
Raffaele De Caro
Carla Stecco
Publication date: 01-12-2018
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 12/2018
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-018-2086-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Morphometric and dynamic measurements of muscular fascia in healthy individuals using ultrasound imaging: a summary of the discrepancies and gaps in the current literature

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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