Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Chiropractic & Manual Therapies
Published in: Chiropractic & Manual Therapies 1/2017

Open Access 01-12-2017 | Research

Musculoskeletal diagnostic ultrasound imaging for thickness measurement of four principal muscles of the cervical spine -a reliability and agreement study

Authors: Cecilie Krage Øverås, Birgitte Lawaetz Myhrvold, Gro Røsok, Eli Magnesen

Published in: Chiropractic & Manual Therapies | Issue 1/2017

Login to get access

Abstract

Background

The reliability of musculoskeletal diagnostic ultrasound imaging (MSK-DUSI) for the evaluation of neck musculature has been sparsely documented in the research literature. Until now, research has featured a limited number of subjects and only few studies have tested for both inter- and intra-reliability using appropriate methodology.

Methods

Four examiners conducted an inter- and intra-rater reliability and agreement study. Fifty females with and without neck pain (NP) between the ages of 20–70 were recruited from October 2014 to April 2015. The muscles that were evaluated were the longus colli (Lcol), the rectus capitis posterior major (Rcpm), the deep cervical extensors (Dce) and the semispinalis capitis (Sscap). Each of the examiners captured ultrasound images of their allocated muscle and measured the thickness of that muscle twice, on separate occasions, for the first part of the intra-rater reliability study. For the second part, a second image of the same muscle was taken on the same subject and measured by the same examiner. The four examiners then met to measure on each other’s images, to test inter-rater reliability. Their results were compared pair-wise using Interclass Correlation Coefficients (ICC) and Bland-Altman plots. Linear regression analysis was performed to evaluate for possible bias.

Results

Inter-rater reliability was found to be good for Lcol and Sscap muscles and moderate towards poor for the deeper Rcpm and Dce muscles. Intra-rater reliability was good for all the muscles, with the exception of the Dce, which was found to be moderate in the second part of the study. The B&A plots showed good agreement, few outliers, and no bias. However, the agreement intervals indicated a measurement error within the variance of the method that may not have been acceptable for these small muscles if the aim is to evaluate change in thickness.

Conclusions

This study found that MSK-DUSI had variable reliability in assessing the thickness of the Lcol, Rcpm, Dce, and Sscap muscles. No bias was demonstrated, but agreement intervals were wide.
Literature
1.
Graham N, Gross AR, Carlesso LC, Santaguida PL, Macdermid JC, Walton D, et al. An ICON overview on physical modalities for neck pain and associated disorders. Open Orthop J. 2013;7:440–60.PubMedPubMedCentralCrossRef
2.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2163–96.PubMedCrossRef
3.
Itz CJ, Geurts JW, van Kleef M, Nelemans P. Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care. Eur J Pain. 2013;17(1):5–15.PubMedCrossRef
4.
Vasseljen O, Woodhouse A, Bjorngaard JH, Leivseth L. Natural course of acute neck and low back pain in the general population: the HUNT study. Pain. 2013;154(8):1237–44.PubMedCrossRef
5.
Skillgate E, Magnusson C, Lundberg M, Hallqvist J. The age- and sex-specific occurrence of bothersome neck pain in the general population--results from the Stockholm public health cohort. BMC Musculoskelet Disord. 2012;13:185.PubMedPubMedCentralCrossRef
6.
Carroll LJ, Hogg-Johnson S, van der Velde G, Haldeman S, Holm LW, Carragee EJ, et al. Course and prognostic factors for neck pain in the general population: results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Spine (Phila Pa 1976). 2008;33(4 Suppl):S75–82.CrossRef
7.
Cote P, Cassidy JD, Carroll LJ, Kristman V. The annual incidence and course of neck pain in the general population: a population-based cohort study. Pain. 2004;112(3):267–73.PubMedCrossRef
8.
Picavet HS, Schouten JS. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain. 2003;102(1–2):167–78.PubMedCrossRef
9.
Jull G, Kristjansson E, Dall'Alba P. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Man Ther. 2004;9(2):89–94.PubMedCrossRef
10.
Boyd-Clark LC, Briggs CA, Galea MP. Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine. Spine. 2002;27(7):694–701.PubMedCrossRef
11.
Falla D, Bilenkij G, Jull G. Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine. 2004;29(13):1436–40.PubMedCrossRef
12.
Treleaven J. Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control--Part 2: case studies. Man Ther. 2008;13(3):266–75.PubMedCrossRef
13.
O'Leary S, Falla D, Elliott JM, Jull G. Muscle dysfunction in cervical spine pain: implications for assessment and management. J Orthop Sports Phys Ther. 2009;39(5):324–33.PubMedCrossRef
14.
Elliott JM, Pedler AR, Jull GA, Van Wyk L, Galloway GG, O'Leary SP. Differential changes in muscle composition exist in traumatic and nontraumatic neck pain. Spine (Phila Pa 1976). 2014;39(1):39–47.CrossRef
15.
Peolsson A, Peolsson M, Jull G, Lofstedt T, Trygg J, O'Leary S. Preliminary evaluation of dorsal muscle activity during resisted cervical extension in patients with longstanding pain and disability following anterior cervical decompression and fusion surgery. Physiotherapy. 2015;101(1):69–74.PubMedCrossRef
16.
Walton DM, Carroll LJ, Kasch H, Sterling M, Verhagen AP, Macdermid JC, et al. An overview of systematic reviews on prognostic factors in neck pain: results from the International Collaboration on Neck Pain (ICON) project. Open Orthop J. 2013;7:494–505.PubMedPubMedCentralCrossRef
17.
Cagnie B, Dirks R, Schouten M, Parlevliet T, Cambier D, Danneels L. Functional reorganization of cervical flexor activity because of induced muscle pain evaluated by muscle functional magnetic resonance imaging. Man Ther. 2011;16(5):470–5.PubMedCrossRef
18.
Kulkarni V, Chandy MJ, Babu KS. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurol India. 2001;49(4):355–9.PubMed
19.
Blouin JS, Siegmund GP, Carpenter MG, Inglis JT. Neural control of superficial and deep neck muscles in humans. J Neurophysiol. 2007;98(2):920–8.PubMedCrossRef
20.
Bexander CS, Mellor R, Hodges PW. Effect of gaze direction on neck muscle activity during cervical rotation. Exp Brain Res. 2005;167(3):422–32.PubMedCrossRef
21.
Anderson JS, Hsu AW, Vasavada AN. Morphology, architecture, and biomechanics of human cervical multifidus. Spine (Phila Pa 1976). 2005;30(4):E86–91.CrossRef
22.
Nolan Jr JP, Sherk HH. Biomechanical evaluation of the extensor musculature of the cervical spine. Spine. 1988;13(1):9–11.PubMedCrossRef
23.
Mayoux-Benhamou MA, Revel M, Vallee C. Selective electromyography of dorsal neck muscles in humans. Exp Brain Res. 1997;113(2):353–60.PubMedCrossRef
24.
O'Leary S, Cagnie B, Reeve A, Jull G, Elliott JM. Is there altered activity of the extensor muscles in chronic mechanical neck pain? A functional magnetic resonance imaging study. Arch Phys Med Rehabil. 2011;92(6):929–34.PubMedCrossRef
25.
Fernandez-de-Las-Penas C, Bueno A, Ferrando J, Elliott JM, Cuadrado ML, Pareja JA. Magnetic resonance imaging study of the morphometry of cervical extensor muscles in chronic tension-type headache. Cephalalgia. 2007;27(4):355–62.PubMedCrossRef
26.
McPartland JM, Brodeur RR, Hallgren RC. Chronic neck pain, standing balance, and suboccipital muscle atrophy--a pilot study. J Manip Physiol Ther. 1997;20(1):24–9.
27.
Abbott R, Pedler A, Sterling M, Hides J, Murphey T, Hoggarth M, et al. The geography of fatty infiltrates within the cervical multifidus and semispinalis cervicis in individuals with chronic whiplash-associated disorders. J Orthop Sports Phys Ther. 2015;45(4):281–8.PubMedCrossRef
28.
Whittaker JL, Teyhen DS, Elliott JM, Cook K, Langevin HM, Dahl HH, et al. Rehabilitative ultrasound imaging: understanding the technology and its applications. J Orthop Sports Phys Ther. 2007;37(8):434–49.PubMedCrossRef
29.
Elliott J, Jull G, Noteboom JT, Darnell R, Galloway G, Gibbon WW. Fatty infiltration in the cervical extensor muscles in persistent whiplash-associated disorders: a magnetic resonance imaging analysis. Spine. 2006;31(22):E847–55.PubMedCrossRef
30.
Falla D, O'Leary S, Farina D, Jull G. The change in deep cervical flexor activity after training is associated with the degree of pain reduction in patients with chronic neck pain. Clin J Pain. 2012;28(7):628–34.PubMedCrossRef
31.
Tagil SM, Ozcakar L, Bozkurt MC. Insight into understanding the anatomical and clinical aspects of supernumerary rectus capitis posterior muscles. Clin Anat. 2005;18(5):373–5.PubMedCrossRef
32.
Enix DE, Scali F, Pontell ME. The cervical myodural bridge, a review of literature and clinical implications. J Can Chiropr Assoc. 2014;58(2):184–92.PubMedPubMedCentral
33.
Stokes M, Hides J, Elliott J, Kiesel K, Hodges P. Rehabilitative ultrasound imaging of the posterior paraspinal muscles. J Orthop Sports Phys Ther. 2007;37(10):581–95.PubMedCrossRef
34.
35.
Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults-an evidence-based approach-part 3: spinal disorders. J Manip Physiol Ther. 2008;31(1):33–88.CrossRef
36.
O'Connor PJ, Rankine J, Gibbon WW, Richardson A, Winter F, Miller JH. Interobserver variation in sonography of the painful shoulder. J Clin Ultrasound. 2005;33(2):53–6.PubMedCrossRef
37.
Rutten MJ, Maresch BJ, Jager GJ, Blickman JG, van Holsbeeck MT. Ultrasound of the rotator cuff with MRI and anatomic correlation. Eur J Radiol. 2007;62(3):427–36.PubMedCrossRef
38.
Peolsson A, Ludvigsson ML, Wibault J, Dedering A, Peterson G. Function in patients with cervical radiculopathy or chronic whiplash-associated disorders compared with healthy volunteers. J Manipulative Physiol Ther. 2014;37(4):211–8.PubMedCrossRef
39.
Lee JP, Tseng WY, Shau YW, Wang CL, Wang HK, Wang SF. Measurement of segmental cervical multifidus contraction by ultrasonography in asymptomatic adults. Man Ther. 2007;12(3):286–94.PubMedCrossRef
40.
Cagnie B, Derese E, Vandamme L, Verstraete K, Cambier D, Danneels L. Validity and reliability of ultrasonography for the longus colli in asymptomatic subjects. Man Ther. 2009;14(4):421–6.PubMedCrossRef
41.
O'Sullivan C, Meaney J, Boyle G, Gormley J, Stokes M. The validity of rehabilitative ultrasound imaging for measurement of trapezius muscle thickness. Man Ther. 2009;14(5):572–8.PubMedCrossRef
42.
Falla D. Unravelling the complexity of muscle impairment in chronic neck pain. Man Ther. 2004;9(3):125–33.PubMedCrossRef
43.
44.
Bland JMAD. Statistical methods for assessing agreement between 2 methods of clinical measurement. Lancet. 1986;8:307–10.CrossRef
45.
Zidan M, Thomas RL, Slovis TL. What you need to know about statistics, part II: reliability of diagnostic and screening tests. Pediatr Radiol. 2015;45(3):317–28.PubMedCrossRef
46.
Ludbrook J. Statistical techniques for comparing measurers and methods of measurement: a critical review. Clin Exp Pharmacol Physiol. 2002;29(7):527–36.PubMedCrossRef
47.
Giraudeau B, Mary JY. Planning a reproducibility study: how many subjects and how many replicates per subject for an expected width of the 95 per cent confidence interval of the intraclass correlation coefficient. Stat Med. 2001;20(21):3205–14.PubMedCrossRef
48.
Karanicolas PJ, Bhandari M, Kreder H, Moroni A, Richardson M, Walter SD, et al. Evaluating agreement: conducting a reliability study. J Bone Joint Surg Am. 2009;91 Suppl 3:99–106.PubMedCrossRef
49.
Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hrobjartsson A, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol. 2011;64(1):96–106.PubMedCrossRef
50.
Hebert JJ, Koppenhaver SL, Parent EC, Fritz JM. A systematic review of the reliability of rehabilitative ultrasound imaging for the quantitative assessment of the abdominal and lumbar trunk muscles. Spine. 2009;34(23):E848–56.PubMedCrossRef
51.
Rankin G, Stokes M. Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses. Clin Rehabil. 1998;12(3):187–99.PubMedCrossRef
52.
Portney LGaW MP. Foundations of clinical research applied to practice. London: Pearson Education Limited; 2014.
53.
Slabaugh MA, Friel NA, Karas V, Romeo AA, Verma NN, Cole BJ. Interobserver and intraobserver reliability of the Goutallier classification using magnetic resonance imaging: proposal of a simplified classification system to increase reliability. Am J Sports Med. 2012;40(8):1728–34.PubMedCrossRef
54.
Elliott J, Jull G, Noteboom JT, Galloway G. MRI study of the cross-sectional area for the cervical extensor musculature in patients with persistent whiplash associated disorders (WAD). Man Ther. 2005;10(2):108–15.CrossRef
55.
Rankin G, Stokes M, Newham DJ. Size and shape of the posterior neck muscles measured by ultrasound imaging: normal values in males and females of different ages. Manual therapy. 2005;10(2):108–15.PubMedCrossRef
56.
Keller A, Gunderson R, Reikeras O, Brox JI. Reliability of computed tomography measurements of paraspinal muscle cross-sectional area and density in patients with chronic low back pain. Spine (Phila Pa 1976). 2003;28(13):1455–60.
57.
Lin YJ, Chai HM, Wang SF. Reliability of thickness measurements of the dorsal muscles of the upper cervical spine: an ultrasonographic study. J Orthop Sports Phys Ther. 2009;39(12):850–7.PubMedCrossRef
58.
Kristjansson E. Reliability of ultrasonography for the cervical multifidus muscle in asymptomatic and symptomatic subjects. Man Ther. 2004;9(2):83–8.PubMedCrossRef
59.
Fernandez-De-Las-Penas C, Albert-Sanchis JC, Buil M, Benitez JC, Alburquerque-Sendin F. Cross-sectional area of cervical multifidus muscle in females with chronic bilateral neck pain compared to controls. J Orthop Sports Phys Ther. 2008;38(4):175–80.PubMedCrossRef
60.
Kamibayashi LK, Richmond FJ. Morphometry of human neck muscles. Spine (Phila Pa 1976). 1998;23(12):1314–23.CrossRef
61.
Rezasoltani A, Kallinen M, Malkia E, Vihko V. Neck semispinalis capitis muscle size in sitting and prone positions measured by real-time ultrasonography. Clin Rehabil. 1998;12(1):36–44.PubMedCrossRef
62.
Mcgaugh J, Ellison J. Intrasession and interrater reliability of rehabilitative ultrasound imaging measures of the deep neck flexors: a pilot study. Physiother Theory Pract. 2011;27(8):572–7.PubMedCrossRef
63.
Javanshir K, Mohseni-Bandpei MA, Rezasoltani A, Amiri M, Rahgozar M. Ultrasonography of longus colli muscle: a reliability study on healthy subjects and patients with chronic neck pain. J Bodyw Mov Ther. 2011;15(1):50–6.PubMedCrossRef
64.
Ishida H, Suehiro T, Kurozumi C, Ono K, Watanabe S. Ultrasound imaging of the diagonal dimension of the deep cervical flexor muscles: a reliability study on healthy subjects. J Bodyw Mov Ther. 2015;19(3):417–20.PubMedCrossRef
65.
Lee JP, Wang CL, Shau YW, Wang SF. Measurement of cervical multifidus contraction pattern with ultrasound imaging. J Electromyogr Kinesiol. 2009;19(3):391–7.PubMedCrossRef
66.
Jesus-Moraleida FR, Ferreira PH, Pereira LS, Vasconcelos CM, Ferreira ML. Ultrasonographic analysis of the neck flexor muscles in patients with chronic neck pain and changes after cervical spine mobilization. J Manip Physiol Ther. 2011;34(8):514–24.CrossRef
67.
Peolsson AL, Peolsson MN, Jull GA, O'Leary SP. Cervical muscle activity during loaded arm lifts in patients 10 years postsurgery for cervical disc disease. J Manipulative Physiol Ther. 2013;36(5):292–9.PubMedCrossRef
68.
Skeie EJ, Borge JA, Leboeuf-Yde C, Bolton J, Wedderkopp N. Reliability of diagnostic ultrasound in measuring the multifidus muscle. Chiropr Man Therap. 2015;23:15.PubMedPubMedCentralCrossRef
69.
Le Cara EC, Marcus RL, Dempsey AR, Hoffman MD, Hebert JJ. Morphology versus function: the relationship between lumbar multifidus intramuscular adipose tissue and muscle function among patients with low back pain. Arch Phys Med Rehabil. 2014;95(10):1846–52.PubMedCrossRef
70.
Javanshir K, Amiri M, Mohseni-Bandpei MA, Rezasoltani A, Fernández-de-las-Peñas C. Ultrasonography of the Cervical Muscles: A Critical Review of the Literature. J Manipulat Physiol Ther. 2010;33(8):630–7.CrossRef
71.
72.
Bogduk N. The clinical anatomy of the cervical dorsal rami. Spine (Phila Pa 1976). 1982;7(4):319–30.CrossRef
Metadata
Title
Musculoskeletal diagnostic ultrasound imaging for thickness measurement of four principal muscles of the cervical spine -a reliability and agreement study
Authors
Cecilie Krage Øverås
Birgitte Lawaetz Myhrvold
Gro Røsok
Eli Magnesen
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Chiropractic & Manual Therapies / Issue 1/2017
Electronic ISSN: 2045-709X
DOI
https://doi.org/10.1186/s12998-016-0132-9

Other articles of this Issue 1/2017

Chiropractic & Manual Therapies 1/2017 Go to the issue

Hypothesis

Contextually Aided Recovery (CARe): a scientific theory for innate healing

Research

Knowledge, attitude, influences and use of complementary and alternative medicine (CAM) among chiropractic and nursing students

Debate

What is chiropractic?

Study protocol

A protocol for clinical trial study of the effect of core stabilization exercises on spine kinematics during gait with and without load in patients with non-specific chronic low back pain

Research

Effect of spinal manipulative treatment on cardiovascular autonomic control in patients with acute low back pain

Research

Friction massage versus kinesiotaping for short-term management of latent trigger points in the upper trapezius: a randomized controlled trial